-;^i 


THE  BOSTON 

jfKebical  anir  ^urgital 

JOURNAL 

THE  OFFICIAL  ORGAN  OF  THE  MASSACHUSETTS  MEDICAL  SOCIETY 

, ar 

,'-"" THURSDAY,  APRIL  1,  1915. ^S^^^iSS^^iS^ 

CONTENTS 
ADDRESSES 

Charles  Sedgwick  Minot,  M.D.    By  W.  T.  Porter,  MJ).,  Boston. 
James  Gregory  Mumpord,  M.D.    By  Richard  C.  Cabot,  MJ).,  Boston. 
ORIGINAL   ARTICLES 

The  Changed  Position  of  the  Profession  of  Medicine. 

By  David  W.  Cheever,  MD.,  Boston. 
The  Menace  of  Syphilis  to  the  Clean  Living  Public. 

By  J.  Harper  Blaisdell,  MJ).,  Boston. 
An  Undescribed  Ulnar  Nerve  Trouble,  Die  to  Tension  prom  Scar,  and  Its  Curb. 

By  F.  J.  Cotton,  M.D.,  Boston. 
Some  Nervous  Appections  in  Which  Mas-^age  Deserves  More  Frequent  Use. 

,  By  J.  W.  Courtney,  M.D.,  Boston. 

MEDICAL   PROGRESS 

Eighth  Rei'obt  op  Progress  in  Orthopaedic  Surgery.    By  Robert  B.  Osgood,  M.D.;  Rob-  . 
ert  Sautter,  M.D.;  Hermann  Bucholz,MJ).; Harry  C.  Low,MJ).;Murray  S.Danforth, 
M.D.,  Boston. 

EDITORIALS 

New  and  Non-ofpicul  Remedies,  1915.  Health  Aspects  of  School  Lunches. 

Syphilis.  The  Question  op  Quarantine  Transfeb. 

Miscellaneous  Matters  of  Medical  Legislation. 

For  rompIMe  table  of  contenti.  N«  first  text  pftye. 


Stiles  on  Nervous  System 


yt/ST  OU7 


Prof.  Stiles*  faculty  of  putting  scientific  things  in  language  easily  grasped  is 
nowhere  better  illustrated  than  in  this,  his  newest  book.  He  has  a  way  of 
conveying  facts,  accurately  with  rifle-ball  precision.  This  new  book  is  really 
a  physiology  and  anatomy  of  the. nervous  system,  emphasizing  the  means  of 
conserving  nervous  energy.  You  get  chapters  on  the  minute  structure  of  the 
nervous  system,  elements  of  nerve  physiology,  reflexes,  anatomy  of  the  nerv- 
ous system,  afferent  nervous  system,  neuromuscular  system  and  fatigue,  auto- 
nomic system,  the  cerebrum  and  human  development,  emotion,  sleep,  dreams, 
causes  of  nervous  impairment,  neurasthenia,  hygiene.         :  : 

12ino  of  2S0  paiTM,  illiutnled.     By  PncT  Ooldthwait  StilB!!,  Inatructor  Id  Phjsiolonr  In  H»nr»rd"OnjT««»y.*''        Cloth, ''(I'.M  iirt. 


Stiles  on  Nutritional  Physiology 


This  work  opens  with  n  brief  but  adequate  presentation  of  the  physiology  of  free-Uvliig  cells  and  leads  up 
to  the  more  complex  function  In  man.  It  takes  up  each  organ,  each  secretion  concerned  with  the  process  of 
digestion,  discussing  the  part  each  plays  In  the  physiology  of  nutrition — In  the  transformation  of  energy. 

12mo  of  275  pa^'Bi,  illuBtratrd.     By  PcRcr  OoLDTiiwiiT  SriLia,  Imtnictor  In  Physioicujy  in  Harvard  University.  Cloth,  $1.26  net. 

W.  B.  SAUNDERS  COMPANY  West  Washington  Square,  Philadelphia 

—  '■  '* — — — * • " —  -    - ■ — ■ —  —  ,. -■''»  ,■■-,.  ,. 

Entered  at  the  Poet-offlct  at  Boaton  aa  aeoond-class  matter 


/\  /' 


11 


BOSTON   MEDICAL  AND  SUBOWAL  JOURNAL 


[APBn,  1,  1915 


HYGIENIC  fRONT-LACED 
CORSETS 

Beneficial  in  all  forms 
of  visceral  ptosis  and 
in  sacro-iliac  strain 

THE  BOSTON  HYGIENIC  CORSET 
COMPANY 

59  TeaiplB  Place   Tilsphou,  Oxford  4131 


E.  F.  M. 

Liquid    Paraffin 

Ib  m)  pxire  tjiat  aromatics  are  not  re- 
quired to  oOTer  up  the  disagreeable 
odor  or  taste  which  is  found  in  most 
of  the  ao-called  Paraffin  OiLs  on  the 
market. 

Our  Ruarian  Oil  maintaina  a  per- 
fect control  of  the  bowels  without  ir- 
ritation, its  action  being  purely 
mechanical  without  purgatiye  prin- 
ciples. 

It  is  extremely  useful  in  surgical 
and  obstetrical  practice. 

We  are  the  sole  importers  of  the 
genuine.  Lane  Oil;  '■  ,•'.  ] 

SamplM  free  to  Hovltais  and  PbyslcUiu. 

E.  F.  MAHADY  CO. 

Surgical  and  Hoapital  Supplies 
673  BoyUton  Street,  Boston,  Mass. 


(Huxttnt  Cttpratur?  iepattttwttt 

ABSTKACTOES. 


John  Bbyant,  M.D.  Rogeb  I.  Lee,  M.D. 

Laurence  D.  Chapin,  M.D.  Geo.  A.  Leland,  Jr.,  M.D. 
Reoinau)  Frrz,  M.D.  Fbancis  W.  Palfkey,  M.D. 

C.  Fbothingham,  Jb.,  M.D.  Edwabd  H.  Risley,  M.D. 
ToBB  W.  Habmeb,  M.D.      Geobqe  G.  Smith,  MJ). 
.T.  B.  Hawes,  2d,  M.D.         Lesley  H.  Spooneb,  M.D. 
Fosteb  S.  Kellogg,  M.D.    Wildeb  Tileston,  M.D. 
Edw.  L.  Young,  Jb.,  M.D. 


MEDICINE. 


The  Reflex  Effects  of  Alcohol  on  the  Cibouiatiok. 


LiEB  (Jour.  A.  M.  A.,  March  13,  1915,  LXIV,  No. 
11,  898)  shows  from  detailed  experimental  evidence 
that  though  whiskey  may  raise  for  a  few  moments 
the  systolic  blood  pressure,  and  thus  act  as  an  ap- 
parent circulatory  stimulant,  inasmuch  as  it  decreases 
cardiac  effleiency.  It  raises  disproportionately  the  dias- 
tolic pressure  and  lowers  pulse  pressure. 


Some  Clinical  Featubes  of  the  Wasseemann 
Reaction. 


Keyes  (Jour.  A.  31.  A..  March  6,  1915,  LXIV,  No. 
10,  p.  804)  makes  the  following  concise  statements 
backed  up  by  a  large  clinical  experience:  A  nega- 
tive Wassermann  is  not  sufBclent  evidence  of'  the 
cure  or  absence  of  syphilis.  A  positive  reaction,  un- 
supported by  clinical  evidence  Is  not  sufficient  evi- 
dence of  the  presence  of  syphilis.  A  positive  reaction 
does  not  prohibit  matrimony.  A  fixed  positive  re- 
action in  the  later  years  of  the  disease  does  not  in- 
evitably point  to  the  prospect  of  brain  lesions.  A 
negative  reaction  after  salvarsan,  in  the  first  year 
of  the  disease,  does  not  mean  that  the  patient  is 
cured,  or  that  lesions  will  not  api)ear  before  the  re- 
action again  becomes  positive.  The  return  of  chancre, 
glands,  eruption  and  positive  Was'sermann  reaction,  a 
few  months  after  control  of  the  disease  by  salvar- 
san In  its  first  few  weeks,  does  not  prove  re-Infec- 
tion. These  are  not  radical  statements,  but  facts 
based  on  large  clinical  observation  of  cases. 

[E.  H.  R.] 

Hormonal  and  Neohobmonal. 


Dencks  (Deutsche  Zeitschr.  f.  Chir.,  November, 
1914)  was  one  of  the  earlier  workers  with  hormonal, 
both  upon  animals  and  in  the  wards.  There  is  no 
doubt  that  this  substance  often  exerted  a  specific 
and  highly  effective  action  upon  the  intestine  in 
,cases  refractory  to  other  medication,  and  in  cases 
in  which  hormonal  alone  was  not  effective,  the 
simultaneous  use  of  atropine  or  physostlgmine  some- 
times accomplished  results  not  brought  about  by  the 
use  of  any  one  of  these  agents  separately.  Hormonal 
had,  however,  one  great  drawback — its  tendency  to 
cause  collapse  through  a  sudden  fall  in  blood  pres- 
sure. 

A  new  form  of  the  old  remedy  has  been  presented 
under  the  name  of  neohormonal,  with  which  Denclts 
has  been  conducting  observations.  The  new  sub- 
stance is  said  to  be  albumose-free,  and  owing  to  this 
improvement,  seems  to  be  free  from  the  tendency  to 
cause  the  undesirable  drop  in  blood  pressure  with 
collapse.  In  the  course  of  forty  observations  upon 
animals  and  one  hundred  and  forty  observations  upor, 
patients,  Dencks  failed  to  observe  any  such  effect. 
Rather  there  appeared  a  transient  rise  In  blood  pres- 
sure with  its  level  then  falling  back  not  below  nor- 
mal, the  pressure  rise  being  paralleled  by  a  rise  and 
fall  to  normal  pulse  rate  and  temperature.  Further 
than  this  Dencks  observed  no  serious  untoward  symp- 

(Continued  on  page  iv.) 


^ 


Vol.  CLXXII,  No.  13] 


BOSTON   MEDICAL  AND   SURGICAL  JOURNAL 


111 


A  highly  appreciated  factor  in  the  use  of 

PANOPEPTON 


is  the  facility  with  which  this  food  for  the  sick  is  obtained,  administered  and 
appropriated. 

PANOPEPTON  is  ever>-where  known  to  physicians,  everywhere  obtain- 
able; is  acceptable  to  the  patient  just  as  it  is*;  appropriated  without  "let  or 
hindrance"  on  the  part  of  the  organism,  and  without  expense  of  energy  or  efifort. 
The  food  substance  of  Panopepton,  the  actual  food  substance  of  entire  beef 
and  whole  wheat,  has  already  undergone  those  "silent  transmutations"  of  phys- 
iological conversion  which  fit  it  for  immediate  utilisation  in  the  body. 

There  are  many  physicians  with  practical  clinical  knowledge  of  Panopepton 
who  say  freely  that  this  food,  through  tlie  facility  and  efficiency  of  its  service  in 
stimulating  and  maintaining  nutrition,  contributes  also  to  the  facility  and  success 
of  the  treatment. 


Fairchild  Bros.  &  Foster 


New  York 


•  May  be  Iced  If  desired,  or  mixed  with   whey,  the  only  food  well  Indicated  for 
admixture  with  Panopepton. 


Powder 

Tablets  In  one-uunce  cattoni 

5  grain..  bo«I«  of  on.  hund  cd  Suppo.itorie. 

and  boic.  of  ten  ,  ^        "       ,  ,    . 

I  J  grain.,  boxe.  or  iix 


Schering  &  Glatz 
150-152  Maiden  Lane,  New  York 


A  soltible.  readily  absorbed 

and  prompthj  excreted, 
pracTtcal.efficient  and  safe 

Hypnotic,  Sedafive 
Antispasmodic 

which  is  firmly  holding  its 
place  again^allnew  comers. 


iii>eimiil 


IV 


BOSTON   MEDICAL  AND   SURGICAL  JOURNAL 


[April  1,  1915 


DISREGARD  OPINIONS 

of  recognized  authorities,  that  exhaustive 
clinical  tests  conclusively  prove  its  de- 
cidedly superior  efficacy  and 

JUDGE  FOR  YOURSELF 

after  carefully  observing  the  certain,  defi- 
nite action,  the  natural  positive  results,  why 


PLUTO 
WATER 

is  unhesitatingly  prescribed  by  practitioners  everywhere 
in  chronic  rheumatism,  gout,  constipation,  obstinate 
intestinal  disturbances,  nephritis  and  simi- 
larly indicated  conditions.  Hygienically 
bottled. 


Samples,  clinical  data,  literature  interest- 
ingly descriptive  of  the  superior  advan- 
tages of  America's  famous  Spa,  promptly 
supplied  by  /\ 

FRENCH    LICK   SPRINGS    HOTEL  CO. 

FRENCH  LICK,  INDIANA 


Daily  usets  of  Vaccines  use  Stjetman's 

SHERMAN'S 
BACTERINS 

Preparations  with  a  Record  for 

RELIABILITY 


Rheumatism  is  a  germ  disease.    Why 
not  use  the  most  logical  treatment, 

Bacterial  Vaccines? 

In  acute  cases  Sherman's  No,  6   has 

proved  very  successful. 

In  chronic  cases  Sherman's  No.  35  is  of  most 

value. 

Local  Distributors 

SAMPSON-SOCtt  CO.,    729  Boylston  Street,  Boston,  Mass. 
E.  r.  MAtlADY  CO.,      671  Boylston  Street,  Boston,  Mass. 

WRITE   rOE   UTERATUKE. 

G.  H.  SHERMAN,  M.D.,   :    :    Detroit,  Mich. 


{Continued  from  page  ii.) 

toms  and  he  feels  that  neohormonal  may  be  used 
with  safety  and  advantage  alone  or  in  combination 
with  atropine  or  physostlgmine,  to  replace  the  more 
dangerous  hormonal  In  such  conditions  as  paresis 
or  obstipation  where  the  older  remetly  would  have 
been  indicated.  [J.  B.] 


How     Shall    We    Tell    Whetheb    ok     Not    the 

MYOCABDrUM   IS    COMPETENT? 


Swan  (Arch,  of  Int.  Med.,  Feb.,  1915)  made  a 
clinical  test  of  the  value  of  some  of  the  procedures 
which  have  been  suggested  for  the  determination  of 
myocardial  efficiency  in  forty  cases  of  cardiac  and 
renal  disease.  The  tests  studied  were:  (1)  The  vari- 
ations in  the  pulse  rate  between  the  recumbent  and 
the  erect  postures;  (2)  The  percentage  of  the  pulse 
pressure  formed  by  the  second  phase  of  the  auscul- 
tatory blood  pressure  reading,  which  is  supposed  to 
indicate  cardiac  strength;  (3)  The  cardiac  efficiency 
factor  of  Tigerstedt,  pulse  pressure  divided  by  sys- 
tolic pressure  (normally  25%  to  35%)  ;  (4)  The  car- 
diac strength-cardiac  weakness  ratio  of  Goodman 
and  Howell,  obtained  by  determining  the  percentage 
of  the  pulse  pressure  formed  by  the  different  phases 
of  the  auscultatory  blood  pressure  and  adding  to- 
gether the  second  and  third  phases  (indicating  car- 
diac strength)  and  the  first  and  fourth  phases  (in- 
dicating cardiac  weakness) — the  normal  ratio  being 
C.  S.  :  C.  W.  ;:  55.5  :  44.4;  and  (5)  The  cardiac 
overload  factor  of  Stone,  determined  from  the  ratio 
of  pulse  pressure  to  diastolic  pressure — the  normal 
ratio  being  50%,  and  anything  in  excess  of  this  rep- 
resenting overload. 

The  writer  concludes  that  all  of  these  factors 
have  some  value  in  determining  the  efficiency  of  the 
myocardium.  He  is  inclined  to  think  that  the  car- 
diac efficiency  factor  of  Tigerstedt  and  the  percent- 
age of  the  pulse  pressure  formed  by  the  second  phase 
are  the  most  important.  A  cardiac  efficiency  factor 
of  40%  or  over  jwints  to  myocardial  inefficiency.  A 
second  phase  of  30%  or  under  indicates  the  same 
condition.  The  C.  S.  :  O.  W.  ratio  is  a  less  reliable 
guide,  but  a  C.  W.  factor  greater  than  the  C.  S.  fac- 
tor indicates  myocardial  disturbance.  The  overload 
factor  of  Stone  is  Indicative  more  of  peripheral  re- 
sistance than  of  myocardial  weakness.  A  cardiac 
load  below  50%,  as  determined  by  this  method,  giv- 
ing a  negative  overload  may  have  some  significance. 
[L.  D.  C] 

A    Report    of    the    Work    Cabeied    Out    at    the 
Radium  Institute,  London,  in  1914. 


Pinch  (Brit.  Med.  Jour.,  Feb.  27,  1915.)  presents 
an  abridged  report  of  the  work  carried  on  in  the 
London  Radium  Institute.  He  first  describes  in  some 
detail  the  apparatus  in  use  for  giving  radium  treat- 
ment, and  the  duration  and  method  of  applications. 

All  tissues  treated  with  radium  respond  in  some 
manner,  but  the  nature  and  extent  of  this  reaction 
vary  greatly,  and  depend  upon :  first,  the  apparatus, 
screening  and  the  dosage  employed ;  second,  the  na- 
ture of  the  tissue  treated ;  third,  the  condition  of  the 
tissue  treated ;  fourth,  the  extent  of  the  area  treated, 
and  fifth,  personal  Idlosyncracy. 

The  reaction  may  take  the  form  of  a  simple  ery- 
thema, or  an  erythema  followed  by  desquamation. 
Occasionally  vesication  with  superficial  ulceration 
takes  pace,  and  rarely  deep  ulceration. 

Pinch  first  discusses  the  results  with  various  forms 
of  carcinomata,  such  as  •epitheliomata,  and  carcino- 
ma of  the  uterus,  bladder,  breast,  rectum,  and  pros- 
tate. Rodent  ulcer  is  the  form  of  malignant  dis- 
ease most  amenable  to  radium  treatment.  The  hy- 
pertrophic nodular  type  vrith  slight  superficial  ulcera- 
tion yields  the  most  satisfactory  results,  whereas  the 
excavating  type  with  undermined  and  overhanging 
edges  often  proves  very  intractable.     Sarcomata,  if 

(Continued  on  page  vi.) 


Vol.  CLXXII,  >o.  13] 


BOSTON   MEDICAL  AND   SUROICAL  JOURNAL 


^^    THREADED   «i« 

nrcURY  BICHLORIDES 

TABLETS 


Safety  First 

Plus 
Accuracy  and 
Efficiency 


r 


"SAFETY  FIRST" 

last  and  all  the  time  to  you  and  your  patient  is  made 
absolute  when  you  order  and  get 

SHARP  &  DOHME'S 
Threaded  Mercury  Bichloride  Tablets 

The  tablet's  blue  color,  trefoil  shape  with  the  word 
"  Poison"-  even  the  bottle's  unique  shape  are  all 
daylight  safeguards.  But  the  Thread  that  is 
the  greatest  of  all  Night- Watchmen.  It  says: 

stopi      Think!      Poisotl! 

Made  only  by 

SHARP  &  DOHME 


Chicago 


CHEMISTS  tince  1860 
BALTIMORE  NEW  YORK 

St.  Louis  New  Orleans  Atlanta 

Seattle  San  Francisco 


Philadelphia 


What  Professor  Lewis  B.  Allyn,  Food  Authority  of  the 
Pure  Food  Town  of  Westfield,  Mass^  says  about 

RING'S  PUREMALT 

*'We  are  enclosing  herewith  analysis  of  samples  of  King's 
Puremalt  recently  received  at  this  laboratory. 

"We  are  particularly  pleased  with  the  low  acidity,  low 
alcohol  and  high  extract  content.  We  believe  this  is  a  product 
of  merit." 


KING'S  PUnEMALT  Is  packed  In  boxes 
containing  1  dozen  and  2  dozen  each,  and 
In  barrels  containing  10  dozen. 

Pronounced  by  the  United  States  Inter- 
nal Revenue  Department  NOT  an  Alco- 
holic Beverage. 

KING'S  PCBEMALT  is  sold  at  all  drug 
stores  and  in  strict  conformity  with  the 
Pure  Food  and  DruK  Act  of  June  30.  1906. 

ASK  ANT  DRUGGIST  ANYWHERE 


ICING'S  PUREMALT  DEPARTMENT 

30-38  Hawlet  Street,  Boston 


VI 


BOSTON   MEDICAL  AND  SURGICAL  JOURNAL 


[April  1,  1915 


THERE    IS    NO    SUBSTITUTE    FOR 

QUALITY    IN   SURGICAL   APPLIANCES 

//  you  miss  U  you  do  not  score  at  all. 


TRADE 


mam 


MARK 


iLASTI  C 
kSTOCKING 


Send  us  your  name  and  address. 
We  want  to  mail  our  catalog 
and  more  particulars  about  the 
POMEROY  idea  of  QUALITY. 

>   Fully  equipped  offices  with  men's 
fitting  department  -  exclusive  ladies' 
department  and  mechanical  shop  - 
located  irjf  the  lollowing  cities: 
NEW  YORK 


16  E.  42nd  Street 
330  Lenox  Avenue 

BROOKXYN 
208  Livingston  St. 

NEWARK 
825  Broad  Street 


CHICAGO 
339  S.  Wabash  Ave. 

BOSTON 
41  West  Street 

.SPRINGFIELD 
(340  Bridge  Street 


(Continued  from  page  it;.) 

taken  In  their  early  stages  before  dissemination  has 
occurred,  do  very  well  under  this  treatment  In 
regard  to  lympljadenoma,  the  striking  feature  of  the 
treatment  of  this  condition  with  radium  is  the  ex- 
treme rapidity  with  which  the  size  of  the  affected 
glands  is  diminished.  The  best  results  are  obtained 
when  the  condition  is  confined  to  the  glands  without 
involvement  of  the  spleen. 

He  describes  his  results  in  various  forms  of  naevl, 
warts,  and  papillomata.  In  tuberculous  glands, 
some  improvement  can  be  obtained,  but  not  if  the 
glands  are  caseating.  He  prefers  to  use  the  Finsen 
light  to  radium  in  treating  lupus.  Occasionally,  re- 
markable results  are  obtained  in  the  treatment  of 
arthritis  deformans,  and  in  some  skin  diseases,  such 
as  keloid  and  pruritus. 

[J.  B.  H.] 

The  Therapeutic  Action  of  Iodin. 


JoBUXG  AND  Petersen  (Arch,  of  Int.  Med.,  Fei., 
1915)  studied  the  therapeutic  action  of  iodin  in  the 
body,  especially  its  effect  in  causing  absorption  of 
necrotic  material.  The  study  here  reported  con- 
cerns the  influence  of  iodin  on  the  antitrypsin  of 
the  blood  and  tissues,  the  writers  believing  that  the 
antitrypsin  is  the  most  important  factor  in  prevent- 
ing the  resolution  of  necrotic  tissues  such  as  are 
found  in  infarcts  and  in  the  caseous  areas  in  syphi- 
lis and  tuberculosis.  They  found  a  great  decrease  in 
anUtryptic  strength  of  guinea-pig  serum  after  treat- 
ment with  potassium  iodide.  In  thirteen  cases  in 
human  beings,  eleven  of  whom  were  syphilltics,  they 
found  that  the  administration  of  iodides  caused  a 
very  considerable  reduction  in  the  antitryptic  activitj- 
of  the  blood.  If  the  action  of  iodin  in  causing  ab- 
sorption of  necrotic  material  is  due  to  the  general 
owering  of  the  antitrypsin,  they  say,  large  doses 
should  cause  an  increase  In  the  nitrogen  output  ow- 
ing to  the  increase  of  proteolysis.  The  results  of  a 
number  of  experiments  with  dogs  Indicate  that  the 
iodides  do  increase  the  nitrogen  output.  In  phthisis, 
when  Iodides  are  taken  Into  the  tissues,  a  portion 
of  the  iodin  is  liberated  and  combines  with  the  un- 
saturated carbon  atoms  of  the  fatty  acids.  As  soott 
as  this  occurs  in  necrotic  tissue  to  a  degree  sufficient 
to  lower  or  remove  the  antlferment  action,  autolysis  en- 
sues, the  caseous  matter  begins  to  soften  and  is  more 
likely  to  rupture  Into  the  bronchi  and  tubercle  ba- 
cilli appear  in  the  sputum  and  may  be  disseminated 
in  the  body.  In  syphilis,  iodides  bring  about  re- 
solution of  the  process  but  are  not  curative  in  the 
sense  that  they  prevent  the  return  of  the  lesions. 
Iodin  neutralizes  the  action  of  the  agents  (unsatu- 
rated fatty  acid  radicals)  which  prevent  solution  and 
absorption  of  necrotic  tissue,  and  at  the  same  time- 
lays  bare  to  the  action  of  the  real  germicidal  agent 
(mercury  or  arsenic)  the  infecting  organism  which 
had  been  protected  by  the  necrotic  tissue. 

fL.    D.    C] 


SURGERY. 


Tbeatment  or  Fractdbe   of  the   Elbow  bt  Hypeb- 

FLEXION     AND    EARLY     IMMOBILIZATION. 


Unholp  and  Wolf  (Surg.,  Oyn.  and  06s.,  March, 
1915)  in  a  well  written  article,  with  many  good  il- 
lustrations, seemingly  demonstrate  that  the  old  idea 
of  late  mobilization  of  the  elbow  after  fracture  is 
an  improper  principle  on  which  to  work.  They  show 
5.3%  of  perfect  results  and  by  perfect  they  mean  ab- 
solutely normal  arms.  They  found  that  the  most 
perfect  results  were  obtained  when  fractures  were 
immobilized  for  the  briefest  period  possible:  the  re- 
sults were  perfect  in  all  of  23  cases  In  which  fixation 
in  hyperflexion  was  combined  with  early  mobiliza- 
tion and  massage.     The  following  table  Is  suggestive : 

(Continued  on  page  viii.) 


\<JU  CLXXII,  No.  13]  BOSTON   MEDICAL  AXD  SURGICAL  JOVRNAL-  yij 


A  Palatable  Way 
To  Take  Agar  Agar 

Agar  Agar  in  its  raw  form  is  not  palatable 
— especially  to  children. 

This  objection  has  been  overcome  and  the 
efficiency  of  Agar  Agar  not  lessened — in 
Mansfield  Agar  Agar  Wafers. 

Made  from  Agar  Agar  and  whole  Wheat — 
these  wafers  are  crisp  and  delicious  and  can 
be  eaten  with  the  meals  as  a  food — or  given 
to  children  during  the  day  in  place  of  cookies 
or  sweets.  They  solve  the  problem  of  how  to 
give  a  laxative  to  a  child. 

On  request  we  will  send  to  any  physician 
a  box  with  our  compliments. 

Druggists  and  grocers  carry  them  in  stock 
or  can  get  them  through  jobbers. 


Mansfield  Laboratories,  Inc. 

Mansfield,  Mass. 


VUl 


BOSTON   MEDICAL  AND   SURGICAL  JOURNAL 


[Apbil  1,  1916 


HOTEL  CUHBERLAND 

NEW    YORK 

Broadway  at  54th  Street 

Near  60th  St.   Subway  Station,   53rd  St.   Elevated,   and 
all  Surface  Lines. 


Near  Hoapltals,  Medical 
Schools  and  Clinics. 

New  and  Fireproof 

strictly  First  Class. 

Rates  Reasonable. 

$2.50  with   Bath   and   Up. 

All  Hardvrood  Floors  and 

Oriental   Rnss. 

lO   Minutes'  Walk   to 
40  Theatres 

Excellent  Restanrant. 
Prteea   moderate. 

Headquarters 
for   Physicians 


Send  for  Booidet 

HARRY  P.  STIMSON 

Formerly  with  Hotel  Imperial 

ONLY     NEW     YORK     HOTEL     WINDOW-SCREENED 
THROUGHOUT 


Directori?  of  "tturses 


EsUbllshed  1807. 


Telephone,  B.  B.  7000 


The  Beal  Nurses'  Home  and  Registry,  Inc. 

20  Charlesgate  West,  Boston. 

226   Resident  Oraduite  Nurses. 

Onidnates,   Experienced  Nurses  and  Attendants  Registered. 

HOURLY   NUR8ING  at  especially  reasonable  rates.     Circulars   regarding  this 

system  sent  on  request.     No  Fee  to  Patrons. 

Ehnlly  M.  Beal,  Mgr. 


OrganlEed  18»».  Telephone,  B.B. 

The  Boston  Nurses'  Club  Registry 

Only  Graduate  Nurses  Registered. 

No  Charge  to  Patrons. 

889  BOTLSTON  STREET,  BOSTOK,  MASS. 

Telephone  Service  Day  and  Night. 


291S. 


Gustaf  Sundelius 

MEDICAL  GYMNAST  AND  MASSEUR 

Graduate  of  Stockholm,  Sweden 

References  to  the  leading  Physicians  In  Boston  and  vidiilty 

WARREN  CHAMBERS,  419  BOTLSTON  STREET. 

Telephone,  B.  B.  4200. 


Wet  Nurse  Directory 

Under  the  direction  and  control  of  the  Infants'  Hospital. 
Wet  nurses  may  be  obtained  by  telephoning  to  the 
INFANTS'  HOSPITAL,  BrookUne  5500,  or  the 

DIRECTORY,  Jamaica  29L 


(Continued  from  page  vi.) 

Mobilization  and  mas.sage  begun    Perfect  Imperfect 
In  first  work  after  Injury                  27  2 

In  second  work  after  injury  19  11 

In  third  worlf  after  injury  6  15 

In  fourth  work  after  injury  0  8 

In  fifth  to  eighth  work  after  injury     1  11 

Also  the  duration  of  treatment  necessary: 

15.7  days  for  fractures  Immobilized  for  1  week. 
24.5  days  for  fractures  immobilized  for  2  weeks. 
23.7  days  for  fractures  immobilized  for  3  weeks. 
36.0  days  for  fractures  immobilized  for  4  weeks. 

They  state  that  hyperflexion  does  not  mean  acute 
flexion,  but  the  most  acute  flexion  in  which  the  el- 
bow can  be  flxed  without  obliterating  the  radial  pulse. 
The  article  is  worth  careful  study. 

[E.  H.  R.] 

Splenectomy  in   Primary  Pernicious  Anemia. 


RoBLEE  {Jour.  A.  M.  A.,  March  6,  1915,  LXIV,  No. 
10,  p.  796)  treats  thoroughly  the  subject  of  splenec- 
tomy in  primary  pernicious  and  associated  anemias. 
He  believes  that  primary  anemia  may  be  due  to  a 
toxin  which  may  be  of  bacterial,  chemical  or  para- 
sitic origin,  which  in  some  cases  causes  an  increase 
in  the  unsaturated  fatty  acids,  and  also  a  hyperemia 
of  the  splenic  pulp  because  of  changes  in  the  splenic 
blood  vessels  which  cause  pulp  engorgement.  The 
presence  of  the  spleen  then  seems  to  cause  a  diminu- 
tion in  the  amount  of  total  fats  and  cholesterins  of 
the  blood  which  are  antlhemolytlc.  Removal  of  the 
spleen  does  not  produce  Injurious  effects  on  the  pa- 
tient. Blood  transfusion  should  always  be  done  prior 
to  splenectomy :  the  latter  operation  causes  a  stun- 
ning remission  of  all  symptoms,  the  blood  picture 
improves  markedly  but  never  returns  quite  to  nor- 
mal. The  Improvement  Is  rapid  but  it  does  not  re- 
move the  cause.  It  seems  that  the  morbid  spleen 
functioning  Is  merely  one  link  in  the  chain  of  fac- 
tors causing  the  disease,  but  by  removing  it  we 
make  a  gap  in  the  chain  which  is  considerable. 

[E.   H.   R.] 

The  Significance  of  Tubercle  Bacilli  in  the  Ubink. 


Brown's  {Jour.  A.  M.  A.,  March  13,  1915,  Vol. 
LXIV,  No.  11,  p.  886)  conclusions  from  a  very 
thorough  analysis  are  that  no  staining  method  dif- 
ferentiates absolutely  tubercle  bacilli  from  smegma 
bacilli,  but  cultural  methods  may  aid  greatly.  Ani- 
mal inoculation  with  the  production  of  tuberculosis 
is  an  absolute  test  but  of  value  only  when  positive. 
The  same  care  about  the  collection  of  the  urine 
should  be  exercised  as  about  the  collection  of  sputum. 
Tubercle  bacilli  can  be  excreted  through  apparently 
normal  kidneys.  Radiography  may  aid  in  the  quick 
detection  of  caseous  foci  when  the  urine  contains 
no  tubercle  bacilli.  Spontaneous  healing  is  often 
fictitious.  The  final,  and  often  best,  treatment  for 
renal  tuberculosis  on  diagnosis  is  nephrectomy  fol- 
owed  by  the  use  of  tuberculin.  Tubercle  bacilli  oc- 
cur in  the  urine  in  genital  tuberculosis  usually  late 
in  the  disease  and  are  consequently  of  little  aid  In 
diagnosis  of  the  condition.  [E.  H.  R.] 


DupuYTREN's  Contraction. 


Black  {Brit.  Med.  Jour.,  Feb.  20,  1915)  discusses 
Dupuytren's  contraction  in  an  interesting  and 
thorough  manner.  This  condition  is  described  as  a 
fibrositis  of  the  palmar  fascia,  not  associated  with 
any  inflammatory  thickening  of  the  skin. 

The  pathology  in  detail  consists  of  a  thickening 
and  contraction  of  the  digital  processes  of  the  palmar 
fascia ;  the  main  body  of  the  fascia  is  affected  sec- 
ondarily.    As  a   result  of  this,  the   fingers   become 

(Continued  on  page  x.) 


Vou  CLXXII,  No.  13] 


BOSTOy   MEDICAL  AND  BVRGICAL  JOURNAL 


IX 


What's  The  Answer  To  The  Surgeon's  Rubber 


Glove  Question? 


You  do  not  have  to  get  used  to  wearing 
Miller  glovee, — they  are  like  a  coat  of 
Bkin — BO  Beneitive  that  you  can  e 
ily    pick    up    a    needle    from    the 
table — give  the  greatest  protec- 
tion    against     infection  —  are 
th«  moat  flexible — have  the 
greatart  tenaile  strength. 


THE  TIME  to  decide  this  question  Is 
when  you  buy  your  rubber  gloves, 
not  after  an  Inferior  pair  has  handi- 
capped your  worH,  or  failed  you  in  a 
crisis.    The  name  "Miller"  on  surgeon's 
gloves  is  a  guarantee  the  world  over  of 
the  highest  quality  and  greatest  ser- 
\ice.     They   are  made   by  the 
makers  of  Miller  ice  bags, 
water    bottles,    surgeon's 
cai>s,    seamless    finger 
cots,  bandages, 
bands,  tubes,  etc. 


Absolute  freedom  from 
lumps  of  rubber,  thin  or 
thickened  spots,  or  in- 
ferior material. 


A  dehcitte  sviuM;  of  touch 
is  preserved  in  the 
quality  of  the  rubber 
used. 


THE     MII>LER     RUBBEB 

COMPANY, 

AKRON,    OHIO,    U.8.A. 


Freedom   of    i'\ery    move 
witbout  exertion. 


No  tension  to  hamper 
the  movement  of  the 
Angers. 


MASSACHUSETTS  GENERAL  HOSPITAL 

Dr.  E.  G.  Brackett  and  Associates  will  give  a  course  of  Clinical  Lectures  in  Orthopedic  Surgery  in 
the  Lower  Amphitheatre  in  the  Out-Patient  Department,  at  10.30,  Thursday  mornings  (excepting  the 
first  exercise,  which  will  be  on  Wednesday),  beginning  March  Slst,  and  continuing  through  April  and 
May. 

The  exercises  will  consist  of  lectures,  clinical  demonstration  of  cases,  the  surgical  anatomy  of  the 
joints  under  consideration,  the  x-ray  interpretation  of  the  condition  included  in  the  exercises,  and  will 
be  followed  with  operations  when  possible.     The  following  subjects  will  be  considered: — 


I  Wednesday,  March  Slst. 
Thursday,  April  8th. 


..] 


Thursday,  April  15th  and  22d. 


General  Methods  Used  in  the  Diagnosis  and  Differentiation   of  Joint 

Disease. 
Tubercular  Disease  of  Spine,  Hip,  Knee. 
Arthritis. 

Etiological  Factors 

Detection  and  Comparative  Significance  of  Various  Joint  Manifestations. 
Treatment 

Affections  of  the  Foot.  1 

Static  Conditions— Foot  Strain,  etc.  [Thursday  April  29th 

Acquired  Deformities  of  the  Foot,  etc.  J 

Postural  Deformities.  T 

Lumbosacral  and  Sacro-lUac  Affections  and  their  Relation  to  Backache     i Thursday,  May  13th  and  20th. 

and  Sciatica.  J 

Knee-joint — Various  Non-tubercular  Affections.  Thursday,  May  27th. 

The  course  is  open  to  graduates  in  medicine  and  students  of  the  third  and  fourth  year,  subject  to 
their  acceptance  by  the  hospital.    Women  are  admitted. 

Given  in  connection  with  Harvard  Graduate  School  of  Medicine. 

A  fee  of  $5  will  be  charged  for  the  course. 

The  hospital  will  be  glad  to  place  the  name  of  any  physician  on  the  mailing  list,  to  receive  an- 
nouncements of  all  graduate  courses. 

Application  should  bp  made  to  FREDERIC  A.  WASHBURN,  Resident  Physician, 

Massachusetts  General  Hospital. 


BOSTON  MEDICAL  AND  SURGICAL  JOURNAL 


[Apeu,  1,  1915 


Double  Service 

Automobile   Tires 

GUARANTEED   7,000  MILES  SERVICE 
ABSOLUTELY    PUNCTUREPROOF 

DOUBLE  SERVICE  TIRES  are  double  the 
thickness  of  the  best  standard  make  tires. 

This  100%  greater  wearing  surface  naturally  gives 
that  much  more  mileage  and  service.  The  average 
of  12  plies  of  tough  fabric  and  one  inch  surface 
tread  rubber  makes  these  tires  ABSOLUTELY 
PUNCTUREPROOF. 

These  tires  excell  all  others  for  use  in  the  country 
over  rough  and  rugged  roads  as  well  as  on  hard 
pavements.  They  are  as  easy  riding  and  resilient 
as  any  other  pneumatic  tire — the  air  space  and  pres- 
sure being  the  same. 

They  are  the  most  economical  and  "care  free" 
tires  made  and  are  used  where  tires  must  be  de- 
pended on  and  tire  troubles  cannot  be  tolerated 
Many  DOUBLE  SERVICE  style  tires  are  in  use 
in  the  United  States  government  and  Europeain  War 
service. 

Our  output  is  limited  to  a  certain  amount,  but  for 
a  short  time  we  offer  the  following  reduced  special 
prices  as  an  INTRODUCTORY  OFFER. 


Cross  Section  of  the  Double  Service  Tire. 

Extra  Heavy 
Tires  Tubes 

28x3"  $  7.25  $2.20 

30  X  3  8.60  2.30 

30x3%"  10.85  3.10 

31x3%"  11.40  3.15 

32  X  3%"  12.75  3.20 

31x4"  14.25  4.00 

32  x  4"  14.90  4.10 

33  X  4"  15.75  4.20 
34X4  16.70  4.35 
35x4"  16.80  4.60 
36x4"  17.45  4.65 
37x4"  17.65  4.70 
35x4%"  21.20  5.60 
36x4y2"  22.50  5.75 
37  x  AW  23.60  6.20 
35  X  5"  24.40  6.35 
36x5"  25.10  6.55 
37  X  5"                    26.30                    6.60 

All  other  sizes  not  included  in  above  list  also  fur- 
nished.    Non-skids  at  10%  additional. 

TERMS:  Payment  vrith  order  at  above  special 
prices,  a  10%  discount  allowed  on  orders  for  two 
or  more  tires.    All  personal  checks  must  be  certified. 

Try  these  tires  and  be  convinced  of  their  very 
high  qualities. 

Not  sold  through  dealers. 

Double  Service  Tire  &  Rubber  Co. 

F4,  Akron,  Ohio 


{Continued  from  page  viii.) 

more  or  less  drawn  into  the  palm,  although  the  flexor 
tendons  are  not  actively  contracted.  The  skin  over 
the  thickened  fascia  may  become  puckered  owing  to 
the  fascia  fibres. 

The  disease  divides  itself  into  four  stages:  first. 
In  which  the  palmar  fascia  only  is  involved;  second, 
in  which  the  fascia  is  involved  and  one  or  more  dig- 
its are  slightly  flexed;  third,  in  which  the  palmar 
fascia  is  involved  and  one  or  more  digits  are  semi- 
flexed; fourth,  In  which  the  palmar  fascia  is  in- 
volved and  one  or  more  digits  are  totally  flexed. 
Black  has  collected  240  cases;  and  finds  that  of 
these,  104  are  bilateral. 

It  occurs  much  more  frequently  In  men  than  in 
women,  and  is  a  disease  of  middle  and  late  life.  It 
often  runs  in  families,  and  seems  to  be  a  disease 
affecting  the  non-working  class  fully  as  much  as  the 
working  classes. 

There  are  two  antagonistic  theories  concerning  its 
causation;  first,  that  it  is  brought  about  by  external 
agencies ;  and  second,  that  it  is  due  to  an  internal  or 
constitutional  factor.  Black  does  not  believe  in  our 
existing  state  of  knowledge  that  the  disease  Is 
wholly  unconnected  with  external  pressure  and  other 
causes,  but  he  does  believe  that  the  external  causa- 
tion theory  has  as  yet  to  be  proved.  He  believes 
that  eventually  this  condition  can  be  shown  to  be 
due  to  a  certain  internal  condition,  possibly  akin  to 
a  gouty  or  rheumatic  condition  among  persons  of 
advancing  age. 

Treatment    is    operative    and    non-operative.      He 
quotes   one   writer  who   believes  that  it  is   a  symp- 
tom of  thyroid  deficiency,  and  who  reports  favorable 
results   with   thyroid   extract.     Operation  is  usually  , 
necessary.  [j.    B.   H.] 


OBSTETRICS  AND  GYNECOLOGY. 


The   Cdbe   of  Adenocabcinoma  of  the  Uterus  by 
Simple  Cueettagex 


BoLDT  AND  Fedinski  {Suvg.,  Qyn.  and  Ohs.,  March, 
1915)  go  extensively  into  the  detailed  pathology  of 
carcinoma  of  the  uterus  both  in  its  early  and  late 
stages  and  cases  are  cited — three  in  all — in  which  a 
cure  has  been  effected  by  simple  curettage  for  diag- 
nosis. This  brings  up  the  question  of  spontaneous 
cure  to  which  these  authors  give  little  credit.  They 
raise  the  very  pertinent  question  as  to  whether  cure 
is  possible  from  curetting  only.  They  warn  also 
against  the  advocacy  of  this  operation  as  a  cure  in 
place  of  the  radical  procedure.  The  discussion  in 
these  papers  is  of  interest  to  those  especially  inter- 
ested in  this  branch  of  work.  [E.  H.  E.] 


Nitrous  Oxid  Gas  Analgesia  in  Obstetrics. 


Webster  and  Lynch  (Jour.  A.  M.  A.,  March  6, 
1915)  make  very  timely  contributions  to  the  subject 
at  a  time  when  the  much-heralded  twilight  sleep  is 
being  advertised  to  the  world  in  the  lay  press.  Webs- 
ter especially  shows  the  Independability  of  this  new 
method  and  relegates  it  to  its  proper  place  in  treat- 
ment. He  then  points  out  the  simplicity,  safety  and 
freedom  from  obstetrical  objections  of  gas  anesthesia 
or  analgesia  during  the  second  stage  of  labor.  It  Is 
vastly  superior  to  ether,  chloroform  or  morfine  in  its 
degree  of  safety  and  lack  of  interference  with  iso- 
tonic contractions  of  the  mother's  musculature.  It 
seems  a  rational  procedure  and  one  worth  more  ex- 
tended trial.  The  administration  does  not  require 
the  skilled  anesthetist  any  more  than  dental  work 
does.  [E.  H.  R.] 


Vol.  CLXXII,  Xo.  13] 


BOSTON   MEDICAL  AXD   SURGICAL  JOURNAL 


XX 


ELECTRIC 
CENTRIFUGES 

AND 

VACCINE 
SHAKERS 

Send  for  Catalog  C 

INT[RNATIONAL  INSTRUMENT 
COMPANY 

23  (HURCH  STRfET     CAMBRIDGE,  MASS. 


Fisk  &  Arnold 

Established  1865 
Oldest  Manufacturers  in  New  England  of 

ARTIFICIAL  LIMBS 

For  Every  Ampn- 
tatlon. 

United  States 

Government 

Bonded 

Manufacturers 

The  procuring  of  (n 
artincial  limb  i<  a 
most  important  matter 
and  the  Doctor  cannot 
afford  to  trust  hia  pa- 
tient in  any  but  the 
most  reliable  hands. 
Our  experience  o  f 
nearly  half  a  century 
guarantees  our  relia- 
bility. 

MANUfACTlJRfRS  Of 
THE  IINCOLN  ARM 

The  AccompanvinK 
cut  illtutrmtes  an  arni 
for  amputatipn  above 
elbow  with  B  p  r  i  n  ff 
thumb,  detachable  hand 
and  elbow  locking  de- 
Tice. 

Full  descriptive  cata- 
lo^e  on  application. 

3  Boylston  Place,  Boston,  Mass. 

Telephone,   Oiford   3684-M. 


Puffed  Wheat  and  Puffed  Rice 

The  Fittest 
Foods  Created 

The  Best-Cooked  Cereals  Known 

Prof.  A.  P.  Anderson,  formerly  of  Co- 
lumbia University,  has  best  solved  the  prob- 
lem of  cereal  digestion.  And  this  is  how  he 
does  it: 

Whole  kernels  of  wheat  or  rice  are  sealed 
in  mammoth  j^uns.  Then  the  guns  are  re- 
volved for  an  hour  in  550  degrees  of  heat. 

The  trifle  of  moisture  inside  of  each 
granule  is  converted  to  steam  by  this  heat. 
When  the  guns  are  shot,  that  steam  ex- 
plodes. There  occur  in  each  kernel  more 
than  100  million  explosions. 

Cooking,  baking  or  toasting  break  up 
part  of  the  granules.  But  this  process  alone 
breaks  them  all.  In  no  other  way  is  wheat 
or  rice  even  half  so  well  fitted  for  easy  di- 
gestion. 

The  grains  are  thus  puffed  to  eight  times 
normal  size.  They  become  fragile  grain 
bubbles,  crisp  and  flaky,  fascinating  to  the 
taste.  They  are  served  with  cream  and  su- 
gar. Or  like  crackers  in  bowls  of  milk.  Or 
eaten  dry  like  peanuts. 

In  many  conditions  which  you  meet 
you'll  find  these  ideal  foods.  They  are  de- 
licious whole-grain  morsels  which  do  not  tax 
the  stomach. 

Package  on  Request 

"We  shall  gladly  mail  to  physicians,  on  request,  a 
package  of  either  Puflfed  Wheat  or  Puffed  Rice.  The 
foods  are  sold  by  all  grocers  at  12c  and  15c  per  pack- 
age, respectively.     Address 

The  Quaker  Q^\s  G>mpany 

Chicago 


xii  BOSTON   MEDICAL  AND   SURGICAL  JOURNAL  '  [Apbii-  1,  1915 


PHILLIPS' 
PHOSPHO-MURIATE  of  QUININE 


COMP. 


An  Aromatic  Syrup  Containing  Phosphoric  Acid  and  Phosphates  of  Potash,  Magnesia, 
Lime  and  Iron  with  Muriate  of  Quinine  and  Strychnine 

A  Reliable  Tonic  and  Reconstructive 

Free  from  Alcohol 


PHILLIPS'  DIGESTIBLE  COCOA 

COMP. 

Made  from  Fine  Selected  Beans  of  Cacao  Theobroma 

A  Delicious  Food  Beverage  and  Valuable  Substitute  for  Tea  or  Coffee 
"THE  COCOA  WITH  A  RICH  CHOCOLATE  FLAVOR" 


Constipation 

in  the  artificially-fed  infant  most  commonly  arises  from 

Faulty  protein  digestion 

Imperfect  fat  digestion 

Lack  of  energy 

Starchy  diet 

and  is  best  corrected  by  making  certain  changes  in  the  proportion  of  the  constitu- 
ents of  the  baby's  diet. 

MellinsFood 

is  of  much  assistance  in  adjusting  the  milk  mixture  to  meet  this  annoying  condition, 
and  we  will  take  pleasure  in  sending,  upon  request,  the  details  of  the  method  of 
procedure  to  meet  individual  conditions. 

Mellins  Food  Company,  Boston,Mass. 


Zbc  JSoeton  nr^ebical  anb  Surgical  Journal 


April  1,  1915 


ADDRESSES. 

Cha«le8  Sedgwick  Hihot,  M.D.    B»  W.  r.  Porter,  M.D.,  Boston  467 
Jium  GuGosr  Mdufobd,  M.D.     By  Richard  C.  Cabot,  MJ)., 
Boston 470 

ORIQINAL  ARTICLES. 

Tub  Chanocd  Position  of  the  PRorEasios  of  Mcdicihe.     By 

David  W.  Cheever,  M.D.,  Boston 478 

The  Menace  or  Svfhilu  to  the  CLEUi-Ln'ixa  Pcsuc.     By 

J.  Harper  Blaitdetl,  M.D.,  Boston 476 

An  Undesoribed  Ulnie  Nerve  Tbooble  Doe  to  Texsioe  frou 

Scar,  and  Its  Curb.     By  F.  J.  Cotton,  M.D.,  Boston 480 

Some  Nertou!i-  Affections  in  Which  Uabsaoe  Desebtis  Kobe 

Fkeqoent  Use.     By  J.  W.  Courtttey,  M.D.,  Boston 483 

ICEDICAL   PR0OBE88, 

EioMTH  Report  of  Proorbsb  in  Orthopaedic  Sdboebt.  By 
Robert  B.  Otgood,  M.D.;  Robert  Soutter,  M.D.;  Btrmann 
BuehoU,  M.D.;  Harry  C.  Low,  M.D.;  and  Murray  S.  Dan- 
forth,  M.D.,  Boston.    (Concluded.) 486 


AdiirfBa^B. 


BOOK  REVIEWS. 

A  Text-Book  of  the  Diseases  of  the  Kose  and  Throat.    By  Jona- 
than Wright,  M.D "1 

EDITORIALS. 

New  and  Nok-Official  Reuedieb,  1915 4M 

Health  Abpects  of  School  Lunches MS 

Stfhilo *•• 

Tm  QicsTioN  OF  Quarantine  Transfer 4SS 

UlfoaLLAEEovs  Matters  of  Medical  Leoislation <M 

Mboioal  Notes* '•T 

CORRESPONDENCE. 

Ttphoid  Fever  in  the  Wrutbrn  Arena  of  War.     "  S." 4»» 

FiBis  Sitbobrt  on  the  Polish  Battle  Feoitt.     BShm 800 

Qdistions  Aboit  the  Harrison  Law.     Henry  Jaekton,  M.D. . .  501 

MISCELLANY. 

Beloiah  Phtsicians'  Reuef  Fdkb 801 

Notices,  Appointments,  Resioxations,  Recent  Deaths,  Books 
AND  Pamphlets  Received 801 


CHARLES   SEDGWICK  MINOT,   M.D.« 
By  W.  T.  PtWTEB,  M.D.,  LL.D.,  Boston. 

Circumstances,  which  should  have  prevented 
the  career  of  Charles  Sedgrwick  Minot,  contrib- 
uted largely  to  its  success — the  usual  paradox. 
He  was  born  not  merely  a  Bostonian,  but  a  leg- 
endary Bostouian.  All  the  crushing  disadvan- 
tages of  an  a.ssured  position,  binding  traditions, 
and  a  competence,  were  his.  The  times  them- 
selves were  not  propitious.  The  range  of 
thought  was  narrow.  Boston  was  no  longer  dis- 
tinctively a  caravan  route.  Strange  cargoes 
were  less  frequent.  The  China  seas  widened 
fewer  horizons.  New  people  were  coming  in, 
floating  on  the  tides  of  unearned  increment. 
Hardy  explorers  from  the  fabled  West  discov- 
ered the  North  Shore.  The  old  society,  solicitous 
for  a  point  of  view  justly  regarded  precious,  took 
refuge  in  its  trenches.  The  use  of  Christian 
names  in  conversation  rose  from  a  convenience 
to  a  shibboleth.  The  spirit  of  the  times  was  aptly 
characterized  by  the  President  of  Harvard  Uni- 
versity, when  he  called  the  Harvard  Medical 
School  of  that  period  a  dinner  club.  Those  were  j 
provincial  days  in  town  and  nation.  j 

Much  may  be  said  of  the  charm  and  indeed 
the  real  value  of  limited  societies,  but  they  are 
unfavorable  to  the  development  of  original  1 
minds.  On  the  other  hand,  once  the  inertia  of 
position  is  overcome,  the  virtues  of  these  partic- 
ular defects  are  admirably  sustaining.  No  doubt 
the  Bostonian  of  literature  was  a  creature  never 
seen  on  land  or  sea,  yet  the  Boston  spirit  was! 

*  Read  at  a  meeting  of  the  Boston  Society  for  Medical  Improve- 
ment, January  25,  1915. 


nevertheless  a  living  force.  There  rests  not  the 
faintest  doubt  that  a  provincialism  which 
pitched  the  note  upon  honesty  of  purpose,  in- 
dustry, and  almost  unexampled  devotion  to 
the  public  welfare,  gave  to  the  neophyte  in  sci- 
ence the  indispensable  weapons  of  his  lifelong 
fight.  In  Minot 's  hands  they  were  never  tar- 
nished ;  honesty,  industry,  and  public  spirit  were 
undimmed  to  the  end. 

These  attributes,  though  suflBcient  for  salva- 
tion in  the  ordinary  walks  of  life,  are  but  the 
tools  of  thought.  The  priceless  gift  is  the  power 
to  see  how  known  phenomena  may  be  so  com- 
bined as  to  reveal  new  truth.  In  the  last  analy- 
sis, the  setting  of  fruitful  problems  is  an  incom- 
municable art.  Yet  those  who  possess  originality 
of  mind  can  be  greatly  helped  by  men  whose 
genius  lies  in  this  direction,  or  by  their  disciples. 
Still  more  may  they  be  aided  toward  the  inven- 
tion of  methods  and  the  development  of  critical 
power.  The  higher  knowledge,  impossible  of 
record,  is  an  oral  tradition.  Minot  received  this 
tradition  from  H.  P.  Bowditch,  Ranvier,  and 
especially  from  Ludwig.  Of  his  debt  to  all  three, 
he  was  ever  conscious.  Ludwig  he  re- 
garded with  true  veneration.  In  this,  Minot 
was  not  alone.  The  illustrious  Heidenhain  .said 
at  Breslau  that  the  only  physiologists  who  had 
really  accomplished  anything  were  Ludwig  and 
Marey.  Ludwig  kindled  fires  in  every  civilized 
country.  The  world  owes  him  a  great  debt,  still 
unpaid.  His  extraordinary  powers  as  a  ferment 
were  coupled  with  an  engaging  simplicity. 
Shortly  before  his  death,  in  his  seventy-second 
year,  he  said :  ' '  The  pity  of  it  is,  I  shall  have  to 
leave  off  just  when  it  becomes  most  interesting." 
Ludwig  gave  to  Minot  the  secret  of  lifelong 
youth,  the  reward  of  those  who  continually  voy- 
age for  discovery. 


356995 


468 


BOSTON  MEDICAL  AND   SUROIOAL  JOURNAL 


[April  1,  1915 


Minot  's  first  physiological  work  was  a  research 
with  Professor  Bowditch  entitled,  The  Influence 
of  Anesthetics  on  the  Vasomotor  Centres.  It  was 
published  in  the  Boston  Medical  and  Surgical 
Journal  in  1874,  more  than  forty  years  ago. 
The  experiments  were  probably  largely  by 
Minot,  but  the  publication  itself  bears  unmistak- 
ably the  marks  of  Bowditch 's  lucid  style  and 
careful  hand.  In  this  investigation  it  was 
shown  that  "in  the  majority  of  cases  the  rise  of 
blood  tension  consequent  upon  irritation  of  the 
saphena  nerve  is  less  marked  when  the  animal  is 
under  the  influence  of  ether  or  chloroform  than 
when  the  anesthetics  are  not  used. ' '  This  result 
is  due  to  a  diminished  activity  of  the  vasomotor 
centre.  Changes  in  the  blood  pressure  were  also 
noted.  Ether  causes  a  rise  in  the  blood  tension 
from  9  to  51  mm.  of  mercury,  while  chloroform 
causes  a  fall  of  from  8  to  37  mm.  The  action  of 
chloroform  on  blood  pressure  is  due  in  large  part 
to  its  influence  on  the  vasomotor  centre  and  only 
in  small  part  to  enf  eeblement  of  the  heart. 

While  at  Leipzig  Dr.  Minot  worked  under 
Ludwig's  direction  on- the  formation  of  carbon 
dioxide  in  resting  and  active  muscle.  This  work 
was  published  in  1876  in  the  Arbeiten  aus  der 
physiologischen  Anstalt  zu  Leipzig.  An  arti- 
ficial circulation  of  blood  serum  was  established 
through  the  biceps  and  the  semitendinosus  fem- 
oris  at  rest  and  during  electrical  excitation  of  the 
muscles.  It  was  found  that  the  carbon  dioxide 
given  off  to  the  circulating  serum  was  not  in- 
creased by  tetanizing  the  muscles.  The  conclu- 
sion was  that  carbon  dioxide  is  not  a  decomposi- 
tion product  of  muscular  contraction.  The 
methods  employed  in  this  investigation,  though 
good  for  the  time,  are  not  altogether  free  from 
loopholes,  and  the  conclusion  reached  is  opposed 
to  our  present  knowledge  that  the  excretion  of 
carbon  dioxide  is  greatly  increased  by  muscular 
contractions.  It  is  therefore  suspected  that  the 
carbon  dioxide  is  after  all  set  free  in  the  muscles 
themselves,  but  the  evidence  is  not  conclusive. 

In  1878  Dr.  Minot  published  in  the  Journal 
of  Anatomy  and  Physiology  his  experiments  on 
tetanus,  made  in  the  Physiological  Laboratory  of 
the  Harvard  Medical  School.  They  showed  that 
when  a  muscle  is  forced  to  contract  by  a  succes- 
sion of  induction  shocks,  the  phenomena  are  es- 
sentially the  same  whether  the  interval  between 
two  shocks  be  several  seconds  or  a  small  fraction 
of  a  single  second.  In  other  words,  the  differ- 
ence between  the  various  forms  of  muscular  con- 
traction depends  merely  upon  the  interval  be- 
tween the  single  shocks  and  the  variations  in 
the  rate  of  the  return  of  the  muscle  to  its  orig- 
inal length.  This  research  was  ingenious,  labo- 
rious, meticulous,  a  conscientious  collection  of 
crumbs  left  by  those  earlier  at  the  feast.  It 
marks  the  end  of  Dr.  Minot 's  first  manner. 

The  paper  on  muscle  contraction,  like  the  two 
preceding  papers,  dealt  with  problems  treated 
from  a  purely  physical  standpoint — an  index  of 
the  times.  Johannes  Miiller,  that  great  genius 
who  is  justly  called  the  Father  of  modern  phys- 


iology, had  begun  the  good  fight  to  place  physiol- 
ogy among  the  true  sciences,  to  express  biological 
phenomena  in  grams,  centimetres,  and  seconds. 
Helmholtz,  von  Briicke,  Ludwig,  and  DuBois- 
Reymond  completed  his  work.  In  my  day,  as  a 
student  in  the  University  of  Berlin,  the  Kneipe 
in  which  physiology  was  given  its  modern  dress 
was  still  pointed  out  to  reverent  youth.  The  job 
was  done  most  thoroughly — so  thoroughly  that, 
after  a  time,  the  method  became  somewhat  irk- 
some to  persons  not  especially  fitted  to  be  sap- 
pers and  miners.  Whether  the  scholastic  excesses 
of  the  physical  school  caused  Minot 's  revolt  or 
whether  his  apostasy  from  the  rigid  sectarians 
was  a  consequence  of  new  studies  connected  with 
his  appointment  to  teach  histology  and  embry- 
ology in  the  Harvard  Medical  School,  I  will  not 
attempt  to  say.  It  is  enough  to  know  that  he 
left  his  foster  nurse  for  what  was  then  called 
biology,  a  hybrid  of  physiology  and  anatomy, 
alleged  at  that  time  to  have  inherited  the  virtues 
but  not  the  faults  of  both  its  parents. 

It  was  a  conscious  and  deliberate  revolt.  In 
that  same  year,  1890,  he  thus  exalts  the  Egeria 
of  his  choice :  "We  should  not  study  merely  the 
organs  of  the  body,  whether  in  their  anatomical 
or  their  functional  relations.  There  are  persons 
who  never  understand  the  arrangement  which 
Nature  has  established.  We  are  always  separat- 
ing things  from  their  natural  connection  and 
taking  up  a  special  series  of  views,  instead  of 
more  general  ones.  There  is  in  the  direction  of 
true  genefal  biology,  a  vast  opportunity  which  I 
hope  will  soon  be  generously  taken  advantage  of. 
There  are  many  things  which  we  can  hope  to 
understand  only  when  study  is  prosecuted  from 
that  point  of  view.  All  of  the  important  phe- 
nomena of  reproduction,  of  heredity,  of  the  evo- 
lution of  species,  and  of  all  the  relations  of 
actual  organisms  to  the  general  economy  of  na- 
ture, of  sex,  of  growth  and  variation,  even  of 
death  itself,  which  is  a  problem  I  believe  capable 
of  scientific  solution; — all  these  things  are  hid- 
den away  to  a  large  extent  from  the  morpholo- 
gist  and  the  physiologist,  they  are  open  to  the 
general  biologist."  {American  Association  for 
the  Advancement  of  Science,  1890,  xxxix,  p.  18.) 

It  is  enough  to  say  that  this  belief  in  the  per- 
fectibility of  the  very  human  biologist  has  not 
yet  been  realized.  The  hope  was  common  in 
those  days.  The  history  of  thought  is  strewn  with 
broken  dreams.  They  rise  like  the  mirage.  The 
weary  traveller,  toiling  through  arid  facts,  as 
numerous  and  as  unrelated  as  the  sands  of  the 
Sahara,  sees  afar  off  the  shining  lakes  of  Theory. 
There,  on  th'e  horizon,  is  that  which  shall  fit  the 
desert  to  be  the  abode  of  men.  The  traveller 
presses  on.  The  mirage  dissolves,  and  from  afar 
the  sphinx,  inscrutable,  looks  down  upon  the  im- 
memorial sand.  The  biologist  may  dress  himself 
tastefully  in  the  plumage  of  the  physiologist  and 
the  anatomist,  but  this  will  not  create  him  a  new 
species.  Dr.  Minot  remained  essentially  a  phys- 
iologist all  his  life,  though,  like  many  physiolo- 
gists, he  worked  from  time  to  time  on  structure. 


Vol.  CLXXII,  Xo.  13]  BOSTON  MEDICAL  AND   SUROWAL  JOURNAL 


469 


His  devotion  to  morphology  had  probably  a 
deeper  source  than  his  special  chair  in  Harvard 
University.    In  his  youth,  the  stamp  of  Ludwig's 
genius  gave  his  mind  a  lasting  impression.  Many 
years  after  the  Leipzig  days,  Minot,  in  a  public 
letter  to  Mosso,  declared  that  from  Ludwig  he 
"had  learned  to  regard  the  living  organism  as  an 
apparatus,  of  which  it  was  necessary  to  learn 
•  both  the  construction  and  the  working,  and  al 
ways  to  seek  the  explanation  of  the  working  on 
the  basis  of  the  construction. "    In  Ludwig's  gen- 
eration this  passed  for  truth.     So  artists  once 
painted  portraits  by  drawing  the  features  and 
afterwards  coloring  them.     They  did  not  know 
that  the  lines  of  a  face  are  not  lines,  but  the 
edges  of  fields  of  light.    Vermeer  marfcs  the  eye 
by  a  clear  light  upon  the  lid  and  a  patch  of  shad- 
ow beneath  it.    The  eye  is  there  in  unsurpas.sed 
perfection  and  not  a  line  is  drawn.    Experience 
has  shown  that  structure  is  an  unsafe  guide  to 
function.     Anatomy  led  the  infant  physiology 
by  the  hand  and  taught  the  gifted  child  some 
lessons  that  did  not  stand  the  test  of  experience. 
It  was   from  the  anatomist,   for  example,  that 
physiologists  got  the  notion  that  the  respiratory 
centre  must  be  a  circumscribed  group  of  nerve 
cells  like  the  nucleus  of  the  hypoglossus.    Eight 
physiologists  found  this  centre  each  in  a  differ- 
ent part  of  the  bulb.     Later  investigators  re- 
moved each  of  these  centres,  but  respiration  still 
went  on.    So  it  was  proved  that  a  community  of 
function  may  exist  in  widely  separated  cells.    A 
physiological  centre  may  or  may  not  be  a  group 
of  cells  closely  related  in  space ;  it  need  only  be  a 
group  closely  related  in  function.    But  Ludwig's 
view  was  orthodox  in  his  day,  and  powerfully  in- 
fluenced his  disciples. 

We  suspect  that  in  his  heart  Dr.  Minot  con- 
cealed a  regret  that  he  could  not  become  a  phi- 
losopher. In  his  letter  to  Mosso  he  says:  "The 
agnostic  position  is  the  only  possible  and  de- 
fensible one  for  a  scientific  man  to  occupy,  who  is 
loyal  to  the  spirit  of  research. — No  hypothesis  of 
life  yet  oflfered  requires  serious  scientific  consid- 
eration. A  confession  of  agnosticism  is  here  a 
positive  contribution  to  the  truth.  On  the  other 
hand,  there  is  no  reason  for  giving  up  the  en- 
deavor to  get  nearer  to  the  final  goal  of  biology 
because  attempts  to  reach  it  by  the  short  cut  of 
speculation  have  always  failed." 

He  was  we  perceive,  wise  enough  to  bind  him- 
self fast  to  the  mast  of  demonstrable  fact,  before 
he  listened  to  the  ravishing  song  of  the  sirens  of 
philosophy.  There  is  a  brave  optimism  in  his 
search  for  an  answer  to  the  problem  of  life.  We 
applaud  the  bold  adventurer  the  more,  because 
he  has  set  his  face  against  the  disheartening  con- 
clusion that  there  is,  at  present,  perhaps  no  log- 
ical hope  that  the  Grail  of  physiological  science 
can  ever  be  found.  The  physiologist  who  seeks 
the  key  of  life  must  proceed  from  established 
premises.  The  established  data  show  that  the 
biological  scene  is  a  succession  of  permutations, 
of  momentary  equilibriums,   of   resultants   ex- 


pressing the  interaction  of  a  multitude  of  fac- 
tors. But  as  soon  as  the  individual  factors  rise 
above  a  number  so  small  as  to  constitute  the  ma- 
jor criticism  upon  our  petty  minds — we  speak  of 
chance.  It  is  probable  that  the  riddle  of  exis1>- 
ence  will  never  be  solved,  because  the  factors  and 
their  possible  interactions  exceed  the  apparatus 
for  their  detection.  No  mental  gifts  will  ever 
make  us  hear  the  high-pitched  sounds  audible  to 
insects,  nor  shall  we  ever  listen  to  the  music  of 
the  spheres. 

Dr.  Minot  began  his  new  scientific  life  by  a 
study  of  growth,  senescence,  and  death,  subjects 
which   occupied   him   for   thirty   years.      Very 
likely  he  was  first  attracted  to  this  field  by  the 
memorable  researches  of  Dr.  Bowditch  on  the 
growth   of  children.      Dr.   Bowditch   often   la- 
mented that  measurements  of  children  in  statis- 
tical quantities  could  hardly  be  obtained  before 
and  after  the  school  age.    Nor  was  it  possible  to 
follow  month  by  month  the  growth  of  thousands 
of  individuals    from    birth    to    maturity.      Dr. 
Minot  determined  therefore  to  study  growth  as 
a  function  of  age  in  one  of  the  higher  vertebrates 
other  than  man.    His  observations  were  begun  in 
the  physiological    laboratory    of    the    Harvard 
Medical  School  about  1885.  Hundreds  of  guinea- 
pigs  were  weighed  every  day  from  birth  up  to 
40  days,  then  every  fifth  day  up  to  215  days, 
then  three  times  a  month  to  the  end  of  the  second 
year  after  birth.    Most  of  the  results  of  this  great 
task  were  published  in  1891,  in  the  English  Jour- 
nal of  Physiology.    One  of  the  most  important 
fruits  of  these  studies  was  the  recognition  of  a 
new  and  more  accurate  method  of  expressing 
growth.    All  previous  investigators  had  figured 
the  absolute  rate  of  growth,  i.e.  the  growth  of  a 
c(hild  in  any  one  year  was  the  number  of  pounds 
gained  in  Uiat  year.    Minot  points  out  that  five 
pounds  gained  by  a  small  child  is  a  greater  gain 
than  five  pounds  gained  by  a  large  child.     The 
true  rate  of  growth,  he  very  rightly  insists,  is 
expressed  by  the  relation  between  the  growth  in 
any  one  year  and  the  weight  at  the  beginning  of 
that  year.     This  is  Minot 's  percentile  rate  of 
growth. 

The  principal  fact  developed  in  the  paper  of 
1891  was  that  there  is  in  guinea-pigs  a  progres- 
sive loss  in  the  power  of  growth,  extraordinarily 
rapid  in  the  early  hours  of  life.  In  the  first 
forty-five  days  the  ability  to  grow  decreases 
four-fifths. 

The  work  with  guinea-pigs  was  followed  by 
valuable  studies  on  intra-uterine  growth. 

Eighteen  years  after  his  first  publication  on 
growth  Dr.  Minot  summed  up  his  studies  in  this 
direction  in  a  book  entitled  Age,  Growth,  and 
Death.  Here  he  demonstrates  that  the  rate  of 
growth  is  highest  at  segmentation  and  from  that 
hour  declines,  at  first  with  great  rapidity  and 
then  more  slowly.  The  period  of  most  rapid 
decline  is  youth ;  the  period  of  slowest  decline  is 
old  age.  If  we  consider  death  to  be  the  bank- 
ruptcy of  an  organism  which  spends  energy  be- 
yond its  income,  the  final  dissolution  is  almost 


470 


BOSTON   MEDICAL   AND   SUROICAL  JOURNAL 


[Apbil  1,  1915 


complete  before  the  highly  efficient  life  in  the 
womb  is  exchanged  for  that  in  a  much  less 
favorable  environment.  The  paradoxes  demon- 
strated as  truths  by  Dr.  Minot's  work  show  us 
how  far  from  correct  are  the  conventional  ideas 
of  life.  Birth  and  death,  the  accumulation  and 
the  discharge  of  energy,  go  on  unceasingly  side 
by  side.  There  are  no  terminal  stations.  En- 
ergy is  a  stream  that  empties  into  its  source, 
and  life  is  a  function  of  time. 

The  book  on  Age,  Growth,  and  Death  treats 
also  of  Dr.  Minot's  views,  first  expressed  in  1890, 
regarding  the  increase  in  the  amount  of  proto- 
plasm within  the  limits  of  single  cells.  By  the 
study  of  the  proportionate  volumes  of  the  nu- 
cleus and  the  cell  body,  he  believed  he  could 
demonstrate  certain  laws  governing  that  pro- 
portion, and  prove  that  the  variations  of  the 
proportion  establish  conditions  which  are  fun- 
damental to  the  correct  conception  of  growth, 
differentiation,  death,  and  sex.  The  most  char- 
acteristic peculiarity  of  advancing  age,  of  in- 
creasing development,  is,  in  Dr.  Minot's  opinion, 
the  relative  growth  of  protoplasm.  The  posses- 
sion of  a  large  relative'  quanity  of  protoplasm  is 
a  sign  of  age.  It  is  essential  to  rapid  growth 
that  the  proportion  of  protoplasm  should  be 
small.  The  development  of  protoplasm.  Dr. 
Minot  taught,  is  the  cause  of  the  loss  of  power 
of  growth. 

It  will  be  observed  that  this  stimulating  but 
incomplete  list  of  Dr.  Minot's  services  to  phys- 
iology touches  but  one  side  of  his  activity.  I 
have  not  spoken  of  his  many  valuable  contribu- 
tions to  morphology,  of  his  text-books,  the  first 
of  which,  especially,  much  enlarged  the  influence 
of  the  young  science  of  embryology;  of  his  ad- 
mirable addresses  at  scientific  meetings  nor  of 
his  ingenious  inventions  such  as  the  rocking  mi- 
crotome. Time  does  not  serve,  nor  can  one  man 
speak  with  authority  of  services  in  so  many 
fields.  Perhaps  the  highest  praise  a  man  can 
have,  is  that  his  biography  must  be  written  by  a 
company  rather  than  by  a  single  individual. 

It  remains  to  speak  of  Dr.  Minot  as  a  friend. 
But  of  his  friendship  and  our  personal  relations 
I  cannot  trust  myself  to  speak.  He  shone 
brightest  in  the  adversity  of  his  friends,  both  by 
his  resolute  bearing  toward  opponents  and  by 
his  counsel.  Of  all  the  words  I  was  privileged 
to  have  from  him,  I  best  remember  his  saying 
that  a  scientist  should  never  consult  his  personal 
happiness  and  that  injuries  were  best  forgiven 
and  forgotten. 

I  believe  that  Charles  Sedgwick  Minot,  the 
friend,  the  comrade,  the  distinguished  scientist 
in  whose  honor  we  are  met,  will  be  in  death  as 
in  life  a  staff  for  the  weak,  a  mark  for  the 
strong,  a  light  to  guide  and  cheer  despondent 
men.  The  weak  will  see'  in  him  a  triumph  over 
circumstance ;  the  strong  will  draw  new  strength 
from  his  unremitting  years  of  high  endeavor; 
and  the  despondent,  averting  their  sad  eyes  from, 
the  fields  on  which  so  many  of  our  ideals  have 
lately  fallen,  will  find  in  his  career  fresh  hope 


and  a  renewed  b'elief  that  life  is  after  all  worth 
living. 


JAMES  GREGORY  MUMFORD,  M.D.* 
By  Richabd  C.  Cabot,  M.D.,  Boston. 

Among  those  who  knew  James  Gregory  Mum- 
ford  and  realized  his  physical  limitations,  it  has 
become  a  familiar  miracle, —  how  he  accom- 
plished the  enormous  and  varied  work  which 
stands  today  to  his  credit.  But  when  one  looks 
back  over  the  remembrances  of  many  years  and 
pictures  the  man,— his  looks,  his  voice,  his  man- 
ner, his  build,— the  victory  over  his  own  temper- 
ament seems  even  more  remarkable  than  his 
conquest  of  physical  handicaps.  He  was  a  re- 
former yet  without  many  of  the  reformer's 
natural  attributes.  Of  the  reformer's  tradi- 
tional buoyancy  and  high  spirits,  he  had  not  a 
trace.  He  was  never  buoyant  or  spontaneously 
expansive.  He  did  not  bubble  over.  He  had 
none  of  the  qualities  of  a  steam  roller;  yet  he 
was  always  pressing  relentlessly  on.  He  was 
thin-skinned,  sensitive,  shy  and  modest,  yet  he 
set  himself  to  push  through  obstacles  that  would 
tear  the  average  man  to  pieces. 

Reformers  are  usually  cock  sure.  Mumford 
was  never  so.  He  had  almost  an  ironic  con- 
sciousness of  human  fallibility,— in  himself 
most  of  all.  His  plans  and  achievements  never 
swept  him  away.  He  was  their  impelling  force 
himself.  In  a  letter  written  in  1910  to  the  sec- 
retary of  his  college  class,  he  portrays  his  work 
without  any  of  the  reformer's  ardor  and  con- 
fidence. 

"So  the  simple  record  runs  on,"  he  says, 
"telling  of  mild  employments  in  the  Harvard 
Medical  School  and  elsewhere.  I  like  teaching; 
students  pass  me  out  the  usual  compliments  due 
to  credulous  senility.  (He  was  47  when  he  thus 
described  himself.)  I  like  practising  surgery; 
patients  toss  me  roses  mingled  with  thorns.  I 
like  writing  about  people  and  things,  for  the 
reviewers  deal  me  comments  which  chasten  the 
soul.  Altogether,  life  continues  a  pleasant  ex- 
perience. I  look  forward  with  composure  to  the 
next  twenty-five  years." 

Anyone  who  did  not  know  his  arduous 
achievements,  his  daring  ideals,  his  ever-renewed 
battle  with  fate  and  conservatism,  might  gather 
from  words  like  these. — indeed  from  most  of  his 
writings,— that  he  took  life  easily,  smilingly,  in- 
dulgently. His  style  has  often  the  light,  whim- 
sical quality  of  one  who  looks  on  with  tolerance 
and  amusement  at  the  crusading  reformers.  Yet 
he  was  himself  a  crusader  and  a  reformer.  His 
life  never  mirrored  the  easy-chair  quality  of  his 
style ;  perhaps  it  was  his  way  of  resting  from  the 
sterner  efforts  of  his  medical  career. 

He  had  the  look  and  manner  of  a  recluse  and 
I  doubt  if  he  was  ever  happier  than  when  alone 
with  his  wife  in  the  woods  or  by  his  library  fire 

•  Read  at  a  meeting  of  the  Boston  Society  for  Medical  Improve- 
ment, January  26,  191B. 


Vol.  CLXXII,  No.  13] 


BOSTON   MEDICAL  AND   SURGICAL  JOURNAL 


471 


The  retiring,  sensitive  side  of  Ms  nature  must 
have  shrunk  even  more  than  the  average  man's 
from  the  buffets  of  a  reformer's  existence.  No 
one  could  have  felt  more  keenly  than  he,  for  ex- 
ample, the  crushing  weight  of  newspaper  criti- 
cism by  medical  colleagues,  as  for  example  at 
the  time  of  his  connection  with  the  Medical  Ad- 
visory Board  of  Emmanuel  Church.  For  he  did 
not  love  a  fight.  There  was  none  of  the  glow  of 
battle  in  his  face.  His  convictions  had  not  that 
tough,  resistant  consistency  that  makes  some  of 
us  the  surer  that  we  are  right  when  every  one 
yells  that  we  are  wrong. 

In  this  paradox  we  face  the  central  mystery 
of  his  life.  His  was  a  fighting  recluse,  a  sensi- 
tive militant,  a  shy  reformer,  a  private  spirited 
publicist,  a  tender  footed  pioneer.  All  this  was 
especially  marked  in  his  later  years.  In  school 
and  college,  the  rift  in  his  nature  was  less  vis- 
ible. It  was  then  his  scholarly  and  refined  tastes, 
not  his  pioneering  spirit,  that  impressed  his 
friends.  Yet  his  life-long  conscientiousness  is 
exemplified  in  the  earliest  of  all  the  stories  told 
of  him.  He  was  born  in  1863.  In  1867,  when 
on  a  drive  with  his  aunt  in  Rochester,  he  was 
shocked  to  see  from  the  height  of  his  four  years 
of  earthly  experience,  a  clothes  line  still  heavy 
with  the  week's  washing,  though  the  week  was 
nearly  over.  "What!  Friday,  and  the  wash  not 
yet  done!" 

That  conscience, — a  New  York  conscience,  not 
a  New  England  one  by  the  way, — is,  I  take  it, 
the  key  to  unlock  the  mystery  of  his  life.  Con- 
science, not  buoyancy,  made  him  optimistic. 
Conscience,  not  fervor,  pushed  forward  his  re- 
forms. Conscience  is  written  into  every  entry 
of  the  journal  where  in  1879  he  listed  the  books 
on  the  shelves  of  his  first  library  at  St.  Paul's 
school.  The  handwriting  is  remarkably  concise 
and  neat  for  a  boy  of  fourteen.  This  book  list 
includes  Mommsen,  Thackeray,  most  of  the  Eng- 
lish and  American  poets,  Shakespeare,  a  good 
many  books  of  travel,  five  volumes  of  the  Lives 
of  Engineers  and  a  few  modern  novels.  "We 
cannot  be  sure  that  he  had  read  them  all,  but 
many  of  them"  had  been  lent  by  him  to  other  boys 
whose  names,  with  the  dates  when  they  took  and 
returned  the  books,  are  methodically  recorded. 
I  think  a  boy  is  more  likely  to  have  read  the 
books  that  he  lends, — especially  when  the  boy 
is  Jim  Mumford. 

This  bookishness  remained  with  him  and  grew 
with  his  growth  from  the  passive  to  the  active 
or  creative  mood.  The  list  of  his  writings  is  im- 
pressive, even  from  its  size. 

Eight  books,*  aggregating  nearly  3500  pages, 
came  from  his  hand  within  twelve  years,  and 
during  a  slightly  longfer  period,  sixty  articles  in 

•  1.  Mumford  Memoirs,  1900, 

2.  A  Narrative  of  Medicine  in  America,  1908. 

8.  Clinical  Talks  on  Minor  Surgery,  1908. 

4.  Surgriral   Aspects  of  Dirc«tivp   Di^nnlcro.   1905. 

6.  Surgical  Memoirs  and  Other  Essays,  1908. 

6.  The  Practice  of  Surgery,   1910. 

7.  One  Hundred  Surgical  Problems,  1911. 

8.  A  Doctor's  Table  Talk,  1912. 

He  was  also   in  editorial   charge  of  the  History  of  the  Hanard 
Medical  School  (3  vols.)  written  by  Dr.  Thos.  F.  Harrington. 


medical  journals.  Many  of  these  articles,  such 
as  that  analysing  300  skull  fractures,  represented 
much  labor.  But  the  quality  and  style  of  thLs 
voluminous  output  makes  it  far  more  impressive. 
Mumford  was  one  of  the  three  or  four  American 
medical  writers  who  has  seriously  tried  to  write 
good  English.  The  German  method  of  dumping 
words  in  piles  upon  a  page  and  leaving  the 
reader  to  deal  with  them  as  best  he  may,  is  that 
followed  by  practically  all  contemporary  writers 
of  American  medicine.  But  this  method  never 
appealed  to  Mumford,  who  had  left  behind 
school-boy  English  before  he  left  school,  and 
ever  after  labored  to  make  his  writings  justify 
the  education  which  he  had  received. 

As  he  was  the  only  Bostonian  who  has  ever 
produced  a  text-book  on  surgery,  and  as  the  vur- 
rent  of  his  interests  flowed  strongly  towards 
teaching,  it  can  hardly  have  failed  to  be  a 
disappointment  to  him  that  he  never  advanced 
beyond  the  rank  of  instructor  at  the  Harvard 
Medical  School. 

But  it  is  doubtful  whether  he  would  ever  have 
desired  to  occupy  the  office  of  a  professor  of 
surgery,  so  long  as  that  oflBce  remained  what  it 
was  and  still  is.  As  early  as  1906,  nearly  ten 
years  ago,  he  foresaw  the  need  of  a  surgical  pro- 
fessor who  should  devote  himself  like  other  pro- 
fessors to  his  office.  That  a  professor  should 
never  be  obliged  to  devote  a  large  proportion 
of  his  time  to  private  practice  in  order  to  make 
a  living,  that  he  should  not  teach  for  a  merely 
nominal  salary  and  should  give  but  a  small  part 
of  his  time  to  teaching  or  study,  is  now  so  gener- 
ally realized  that  the  anomaly  will  soon,  I  believe, 
be  remedied  in  the  Harvard  Medical  School. 
But  in  1906, — nine  years  ago, — there  were  few 
who  dared  to  hope  for  such  a  high  standard  of 
instruction.  The  amateur  clinical  teacher  was 
the  accepted  and  inevitable  portion  of  every 
medical  school  but  one  in  the  country.  That  he 
saw  years  before  the  rest  of  us  the  step  that 
medical  teaching  would  take  next,  by  making 
clinical  professors  full-time  men.  was  entirely 
characteristic  of  the  man.  We  shall  find  it  true 
in  all  the  great  interests  of  his  life. 

One  of  those  interests  was  religion.  He  was 
old-fashioned  enough  to  believe  in  God,  in  mar- 
riage and  in  other  eternal  truths  to  which  the 
excesses  of  modern  enlightenment  have  for  the 
time  very  generally  blinded  our  eyes.  He  be- 
lieved that  the  human  body  in  sickness  and  in 
health  is  usually  inhabited  by  a  soul,  and  he 
cherished  the  still  more  unpopular  belief  that  a 
man's  soul  may  conceivably  be  as  well  known 
to  a  clergyman  who  had  given  it  his  life-long 
study  as  to  a  doctor  who  has  studied  it  but  fit- 
fully and  as  a  secondary  interest.  Believing 
this,  he  thought  it  not  impossible  that  a  clergy- 
man might  help  a  doctor.  He  never  believed 
that  a  clergyman  should  practice  medicine  but 
he  was  firmly  convinced  that  a  doctor  should  not 
delude  himself  with  the  belief  that  he  owns  his 
patient.     That  the  two  professions  could  work 


472 


BOSTON  MEDICAL   AND   SURGICAL  JOURNAL 


[Apbil  1,  1915 


simultaneously  for  one  patient's  good  was  the 
belief  underlying  what  was  called  some  years  ago 
the  Emmanual  movement.  Like  Elwood  Wor- 
cester, the  leader  of  this  movement,  Mumford 
hoped  that  the  doctors  would  be  convinced  of 
this.  But  they  remained  unconvinced  and  as 
a  piece  of  genuine,  widespread  and  whole- 
hearted cooperation  between  minister  and  doctor, 
the  attempt  failed,  because  the  doctors,  as  a  rule, 
had  a  low  opinion  of  the  ministers. 

Nevertheless,  I  have  no  doubt  that  in  this,  as 
in  his  other  hopes,  Mumford  was  ahead  of  his 
age,  in  1908-9,  not  behind  it,  and  that  in  some 
form,  his  attempt  will  yet  succeed. 

Cooperation  between  doctor  and  minister  was 
the  ideal  of  this  lost  cause, — cooperation  was  also 
.  the  key  note  of  the  next  reform  which  in  1910 
Dr.  Mumford  tried  to  effect.  The  Emergency 
Hospital  (now  Grace  Hospital)  on  Kingston 
street,  was  then  in  the  market.  This  hospital 
had  always  been  managed  upon  a  partially  co- 
operative basis.  That  is,  people  paid  a  small 
fee  yearly  for  treatment  there  and  the  physicians 
attached  to  it  were  supposed  to  get  their  living 
— in  part  at  least — out  of  these  fees.  Mumford 
believed  that,  although  faulty  in  execution,  this 
plan  marked  out  in  essentials  the  right  way  to 
support  a  hospital  and  to  get  adequate  treatment 
for  the  vast  number  of  people  of  moderate 
means  who  now  get  the  worst  medical  and  sur- 
gical treatment  that  a  civilized  community  per- 
mits. He  wanted  to  supply  the  needs  of  those 
who  will  not  go  to  a  free  hospital  clinic  or  who 
are  refused  admittance  there,  but  who  are  still 
unable  to  pay  the  high  prices  which  accurate 
diagnosis  and  rational  treatment  necessitate. 
He  knew  that  the  poor  who  visit  free  hospital 
clinics  are  now  getting  better  treatment  than 
any  but  the  very  rich.  He  wanted  to  bring  good 
medical  service  within  the  reach  of  every  one. 

To  do  this  he  proposed  that  the  old  Emer- 
gency Hospital  should  be  secured;  that  a  pro- 
spectus should  be  issued  explaining  the  plan  of  a 
cooperative  hospital,  of  which  he  was  to  be  the 
surgical  head  and  I  the  medical  head.  Each 
of  us  was  to  organize  a  staff  of  physicians  to  do 
under  our  supervision  the  work  of  the  hospital 
and  to  be  paid  out  of  the  fees  of  subscribers 
who  were  to  contribute  so  much  a  year  for  the 
right  to  be  treated  there  without  further  charge. 
Dr.  Mumford  believed  that  with  adequate  lab- 
oratories and  x-ray  outfits,  with  a  proper  system 
of  group  diagnosis  by  a  combination  of  men, 
each  expert  in  his  own  field,  and  by  furnishing 
to  every  patient  the  degree  of  sympathy,  cour- 
tesy and  consideration  now  given  by  the  private 
physician  and  omitted  in  most  free  clinics,  the 
hospital  could  be  made  so  attractive  that  it 
would  pay.  Science  and  sympathy  he  believed 
could  be  combined  and,  by  proper  organization 
at  a  hospital,  could  be  made  available  for  every 
one  at  a  low  price,  while  yet  providing  good 
salaries  for  the  physicians. 

Some  form  of  cooperation  both  with  the  min- 
isters of  religion  and  with  social  service  workers 


he  also  hoped  to  bring  about  at  the  new  hospital. 
In  short,  all  that  we  both  had  failed  to  accom- 
plish elsewhere,  we  hoped  here  to  attain.  The 
plan  was  wholly  his  and  had  it  succeeded  the 
credit  would  have  been  wholly  his.  We  got  as 
far  as  a  typewritten  prospectus, — written  by 
him.  Then  the  scheme  fell  through  for  lack 
of  funds. 

I  have  told  of  this  plan  in  detail  because, 
though  it  came  to  nothing  in  Boston,  it  was  im- 
doubtedly  a  precursor  in  Dr.  Mumford 's  mind 
of  his  Clifton  Springs  undertaking.  Hopes 
nourished  during  the  time  when  he  was  trying 
to  figure  out  the  Cooperative  Hospital  on  King- 
ston street  took  a  further  lease  of  life  when  it 
was  proposed  to  him  to  become  Physieian-in- 
Chief  of  the  Clifton  Springs  Sanitarium. 

That  title  deserves  a  moment's  notice.  Not 
surgeon-in-ehief  but  physician-in-chief  was  the 
name  of  his  office.  As  head  of  the  institution, 
he  succeeded  Dr.  Charles  P.  Emerson,  an  intern- 
ist. This  he  was  perfectly  fit  to  do  because  of  his 
long  experience  of  general  medical  practice  dur- 
ing his  summers  at  Nahant.  For  12  years,  from 
1894  to  1906,  he  spent  nearly  half  of  each  year 
in  general  family  practice,  including  in  the 
earlier  years,  very  little  surgery.  This  broad 
and  varied  experience  prepared  him  to  be  the 
Physician-in-Chief  of  an  institution  where  sur- 
gery was  by  no  means  the  central  interest. 

"I've  agreed  to  take  this  big  institution,"  he 
writes  in  August,  1912,  "and  build  it  up,  getting 
together  a  high-grade  staff  and  other  trifles. 
There's  a  great  opportunity,  great  interest  and 
great  promise.  I  shall  not  be  cut  off  from  Bos- 
ton. I  am  retaining  a  surgical  lectureship  ia 
the  University  and  shall  come  each  year  to  give 
a  course  or  courses.  I  am  feeling  well  and  chip- 
per."  This  was  scarcely  six  months  after  his 
second  serious  breakdown,  an  attack  from  his 
life  long  enemy,  rheumatic  heart  trouble,  which 
two  years  later  cost  him  his  life.  With  the  ir- 
repressible hopefulness  that  had  been  but  tem- 
porarily checked  by  the  failure  of  the  coopera- 
tive hospital  scheme  in  Boston,  he  plunged  into 
his  last  and  best  crusade,  the  attempt  to  make 
out  of. Clifton  Sanitarium  a  great  cooperative 
medical  and  surgical  institution.  Despite  the 
splendid  leadership  of  his  predecessor.  Dr.  C.  P. 
Emerson,  the  staff  had  not  been  thoroughly  re- 
organized, so  that  Dr.  Emerson's  new  methods 
had  not  been  able  to  permeate  and  reinvigorate 
the  old  institutiom  It  had  remained  a  place 
where  people  went  to  rest  and  sometimes  stayed 
to  rest  indefinitely.  Mumford  began  to  make 
of  it  an  active  institution  where  people  could  be 
treated  and  put  back  into  the  world  fit  to  work. 
Under  his  inspiring  leadership  a  splendid 
body  of  young  physicians  and  surgeons  was  rap- 
idly being  accumulated  and  the  methods  and 
standards  of  the  place  were  being  modernized, 
when  a  difference  of  policy  between  Dr.  Mum- 
ford and  the  financial  heads  of  the  institution 
led  to  his  resignation,  very  shortly  before  his 
death. 


Voi,  CLXXII,  No.  13] 


BOSTON  MEDICAL   AND   SVROWAL  JOURNAL 


473 


As  we  look  back  over  this  record  of  Dr.  Mum- 
ford  's,  we  might  well  interpret  it  as  one  devoted 
to  lost  causes.  He  did  not  see  established  at 
Harvard  such  a  full  time  Professorship  of  Clin- 
ical Surgery  as  he  might  well  have  aspired  to 
fill.  He  did  not  live  to  see  that  closer  coopera- 
tion of  doctor  and  clergyman  for  which  in  the 
Emmanuel  movement  he  had  hoped.  In  Bo.ston 
and  later  in  Clifton  Springs  his  eagerness  to 
■organize  a  cooperative  hospital,  serving  the 
whole  public,  received  a  check.  Yet  he  was 
never  and  could  never  have  become  a  disap- 
pointed man.  He  lived  by  faith  and  not  by 
sight.  He  knew  that  the  reforms  he  fought  for 
must  come  to  pass  sooner  or  later.  He  be- 
queathed his  unfinished  task  to  us.  We  have 
taken  from  his  hands  the  tools  he  was  forced  to 
lay  down.  Two,  at  any  rate,  of  the  three  medi- 
cal reforms  for  which  he  lived  and  died, — full 
time  clinical  professorships  and  a  medical  clinic 
where  every  one,  no  matter  how  rich  or  how 
poor,  can  be  treated  by  physicians  paid  out  of 
the  fees  thus  collected, — these  two  reforms  I  be- 
lieve we  shall  see  carried  out  here  in  Boston 
within  the  next  few  years.  That  is  what  he 
most  wanted, — the  goal  itself,  not  his  personal 
share  in  it.  He  ran  his  distance  and  passed  on 
his  message  to  us. 

We  are  here  to  commemorate  James  Gregory 
Mumford.  The  sincerity  of  that  intention  will 
be  manifest  when  we  dedicate  ourselves  afresh 
to  the  task  for  which  he  gave  ' '  the  last  full  meas- 
ure of  devotion"  when  we  "here  highly  re- 
solve that  he  shall  not  have  died  in  vain."  To 
us  is  bequeathed  the  task  he  left  unfinished, 
that  his  ideal  of  medical  service  organized  by 
the  medical  profession  for  all  the  people  shall 
be  made  a  reality  in  America. 


(Original  ArtirUa. 


THE  CHANGED  POSITION  OF  THE 
PROFESSION  OF  MEDICINE. 

By  David  W.  Cheetbb,  M.D.,  Boston. 

Having  begian  the  study  of  medicine  in  1854, 
and  its  practice  in  1858,  I  can  look  back  over 
sixty  years  of  medical  events;  besides  this,  be- 
ing descended  from  two  generations  of  doctors, 
medical  influences  surrounded  me  from  child- 
hood. I  therefore  feel  that  I  am  qualified  to 
survey  all  this  period,  while  excusing  inyself 
from  too  much  egotism.  Two  great  changes  jn 
medicine  will  naturally  occur  to  everyone, 
namely,  anesthesia  and  asepsis.  These,  how- 
ever, I  do  not  feel  it  necessary  to  detail,  but 
shall  confine  myself  to  two  classes  of  influences, 
one  external  or  arising  from  outward  circum- 
stances, the  other  originated  by  the  doctor  him- 
self.    Naturally  we  must  consider  the  external 


circumstances  first;  but  before  doing  so,  it  will 
be  useful  to  glance  at  the  real  condition  of  the 
medical  profession  in  my  childhood. 

Active  interference  with  disease  and  the  use 
of  strong  remedies  were  in  vogue.  Deadly  min- 
eral poisons,  such  as  antimony,  mercury,  and 
lead,  were  largely  used.  Emetics,  now  rarely 
used,  were  habitually  employed,  and  sometimes, 
I  think,  with  benefit.  There  was  a  strong  feel- 
ing that  unhealthy  influences  could  be  expelled 
from  the  body  by  purgatives.  These  were  freely 
and  frequently  used.  It  was  thought  that  the 
taking  of  blood  from  the  body  by  repeated  vene- 
section reduced  fever  and  led  to  the  generation 
of  a  new  and  better  blood.  It  was  an  old-fash- 
ioned habit  with  a  good  many  people  of  adult 
or  middle  age  to  be  bled  once  a  year,  whether 
sick  or  not,  as  a  sanitary  measure.  My  father 
bled  people.  I  myself  have  sometimes  bled  pa- 
tients by  venesection,  and  in  properly  selected 
cases  I  am  convinced  it  is  a  remedy  of  value. 
All  sorts  of  spring  medicine,  or  "spring  cleans- 
ing" as  I  call  it,  were  popular,  and  they  are 
popular  still.  The  other  remedies  mentioned 
have  mostly  fallen  into  disuse.  It  thus  can  be 
.shown  that  the  medical  mind,  and  hence  the 
popular  mind,  were  very  much  in  favor  of  con- 
sidering disease  as  an  entity,  which  could  be 
"knocked  out,"  so  to  speak,  by  a  sharp  counter- 
blow given  by  the  doctor. 

Under  these  circumstances,  about  the  year 
1850 — I  cannot  be  precise — there  arose  a  great 
medical  doubt.  Sir  John  Forbes  in  England, 
Dr.  Jacob  Bigelow  and  Dr.  0.  W.  Holmes  in 
America,  enunciated  a  new  theory,  as  follows: 
that  all  diseases  were  self-limited,  having  a 
natural  rise,  progress  and  decline,  and  hence 
were  little  influenced  by  medicine.  If  this  were 
true,  it  naturally  followed  that  it  was  the  best 
policy  for  the  doctor  to  care  for  the  patient  by 
watching  his  symptoms  rather  than  by  using 
very  active  medication  of  uncertain  power. 
From  this  arose  what  was  called  Expectant 
Treatment :  to  wait  on  Nature ;  to  be  sure  to  do 
no  harm,  if  you  could  do  no  good. 

I  must  be  allowed  to  return  a  mo- 
ment to  myself.  I  did  not  seriously  study 
medicine  until  I  was  twenty-three  years 
old.  I  was  fairly  mature;  I  had  had 
large  collateral  reading;  I  absorbed  these  doc- 
trines and  I  wrote  them  up  in  the  North  Amer- 
ican Review  and  in  a  Prize  Essay.  I  entered 
upon  the  study  of  medicine  with  an  intensity 
which  proved  that  I  had  chosen  the  right  call- 
ing. These  nullifying  doctrines  had  a  very  de- 
pressing effect  on  me.  What  was  the  use  of 
practising  an  art  which  could  promise  so  little? 
I  almost  felt  tempted  to  give  up  my  profession. 
Fortunately  for  me,  I  was  led  to  continue  the 
study  and  teaching  of  anatomy  for  eight  years, 
and  thus  passed  on  to  the  pursuit  of  surgery,' 
\yhere  I  found  solid  ground.  As  time  went  on^ 
like  all  other  doctors  of  my  time,  I  did  practise 
medicine  as  well  as  surgery.  Experience  taught 
me  that  the  doctrine  of  self-limited  disease  was 


474 


BOSTON   MEDICAL   AND   SURGICAL   JOURNAL 


[Apeil  1,  1915 


not  all  true,  that  there  was  something  in  drugs; 
on  some  I  learned  to  rely;  and  I  still  believe 
they  are  useful. 

All  this  personal  digression  is  for  the  purpose 
of  trying  to  bring  before  the  reader  the  exact 
condition  of  medical  practice  about  fifty  years 
ago.  We  are  now  ready  to  consider  those  influ- 
ences which  changed  medicine,  arising  from 
without.    And  the  first  of  these  is  Homeopathy. 

This  novel  and  peculiar  belief,  "made  in  Ger- 
many," never  attained  its  full  vigor  in  the  land 
of  its  birth;  prevailed  very  moderately  in 
France,  but  to  a  greater  extent  in  England.  It 
received,  however,  a  prompt  recognition  among 
certain  of  the  more  educated  classes  in  this 
country  and  attained  here  an  exotic  growth; 
following  soon  after  the  introduction  of  the 
speculative  views  of  German  philosophy,  it 
seemed  to  some  to  ally  itself  with  them  and  to 
be  a  new  advance  in  reasoning.  It  had  two  dog- 
mas :  one  that  the  strength  of  medicines  was  in- 
creased by  minute  division  and  sub-division ;  the 
other  that  if  a  drug  taken  in  health  produced 
certain  symptoms,  it  would  affect  or  cure  any 
diseased  condition  which  was  characterized  by 
like  symptoms.  Those  who  professed  this 
method  necessarily  rejected  the  older  methods 
which  opposed  it.  Hence  the  physician  who  was 
old-fashioned  or  regular  rejected  this  belief  as 
an  exclusive  and  one-sided  dogma  which  denied 
all  other  things  which  he  believed  true;  and  as 
these  new  views  were  diametrically  opposed  to 
his  own  as  to  the  treatment  of  the  sick,  he  was 
consistent  in  refusing  a  consultation  with  the 
homeopathic  doctor,  because  it  could  do  no  good. 
This  new  practice  attracted  many  people  from 
the  better  classes  and  proportionately  dimin- 
ished the  clientele  of  the  regular  doctor.  Ho- 
meopathy for  some  years  increased,  founded 
schools,  endowed  hospitals,  established  medical 
societies,  divided  the  public  into  sects  of  med- 
ical belief.  As  time  wore  on,  it  grew  less  dis- 
tinctive, and  the  methods  of  old  or  regular 
practice  supplanted  it  to  a  large  extent. 

Meanwhile  another  new  belief  in  healing,  of 
a  semi-religious  character,  calling  itself  Chris- 
tian Science,  or  Mental  Healing,  arose.  Its  doc- 
trine was  that  the  will  could  control  organic 
processes  either  wholly  or  to  a  much  greater  de- 
gree than  had  previously  been  supposed.  It 
encouraged  all  weakly  people  to  try  to  get  well 
by  themselves ;  and  to  a  certain  degree  its  influ- 
ence was  salutary.  But  when  it  undertook  to 
cope  with  acute  or  contagious  disease  or  to  seek 
to  control  the  heart,  the  stomach,  the  bowels,  the 
uterus,  which  were  constituted  by  nature,  and 
purposely  so,  to  be  beyond  the  influence  of  the 
will,  it  failed.  The  bacteria  of  diphtheria,  un- 
restrained by  Christian  Science,  were  diffused 
among  other  members  of  a  family;  pneumonia 
was  encouraged  to  will  to  be  well,  and  the  pa- 
tient sometimes,  rashly  exerting  himself,  has- 
tened  a  fatal  result;   the  retained  secundines 


at  childbirth  destroyed  the  patient  by  a  fatal 
flooding,  when  the  will-power  failed,  as  it  must 
fail,  to  contract  the  uterus.  The  mixture  of  re- 
ligious belief  with  these  medical  theories  influ- 
enced and  attracted  very  many  people,  and  are 
still  in  our  own  day  an  obstacle  to  medical  prac- 
tice, although  the  brilliant  advance  of  medicine 
in  laboratory  methods,  making  our  profession  a 
new  science,  will  gradually  overcome  them.  - 

The  next  change  in  the  last  half-century  was 
the  entrance  of  women  into  the  medical  profes- 
sion. The  new  woman,  emerging  from  the  se- 
clusion of  inherited  Puritanism,  now  demanded 
admission  into  our  ranks.  The  regular  physi- 
cians hesitated  to  admit  her  claims  for  two  rea- 
sons: first,  that  her  presence  at  medical  meet- 
ings would  interfere  with  freedom  of  discus- 
sion; second,  that  many  patients  of  either  sex 
would  object  to  being  examined  in  detail  in  the 
presence  of  both  sexes,  and  that  to  render  such 
a  patient  unconscious  by  anesthesia  and  then 
submit  him  or  her  to  such  an  examination  was 
unfair.  These  fears  have  proved  to  be  well- 
founded.  However,  women  have  freely  entered 
the  medical  profession ;  and  practise,  so  far  as  I 
know,  every  form  of  surgery,  as  well  as  medi- 
cine and  obstetrics.  It  must  be  conceded,  how- 
ever, that  their  services  are  largely  limited  to 
their  own  sex. 

An  important  influence  on  the  materia  medica 
employed  by  the  physician  was  now  exerted  by 
the  enormous  advance  in  chemistry.  "We  can  al- 
most say  that  it  has  revolutionized  the  relation  of 
the  druggist  to  the  doctor.  The  latter  had  relied 
on  a  druggist  of  repute  to  select  pure  drugs  and 
to  compound  them  under  the  doctor's  direction 
by  the  so-called  prescription.  The  relations  of 
doctor  and  druggist  were  thus  intimate;  each 
relied  on  the  other.  But  now  new  modes  of 
manufacture  and  new  remedies  made  by  syn- 
thetical chemistry  have  taken  the  place  of  many 
of  the  old  tinctures  and  pills.  As  another  in- 
stance, the  extraction  of  alkaloids,  or  the  active 
principle  of  drugs,  has  furnished  concentrated 
remedies  in  minute  and  cleanly  form;  these 
alkaloids  are  also  indispensable  in  the  sub- 
cutaneous administration  of  remedies.  Being 
more  palatable,  the  new  medicines  furnished  by 
chemistry  are  more  sought  after  by  the  public; 
thus  they  have  contributed  to  enlarge  the  use  of 
proprietary  medicines  to  the  detriment  of  the 
ignorant;  the  abuse  of  narcotics  is  thus  par- 
tially to  be  explained.  It  is  fair  to  consider, 
however,  that  the  supposed  purity  of  materials 
and  the  supposed  accuracy  of  manufacture  de- 
pend upon  the  reputation  of  the  manufacturing 
chemist. 

Finally,  among  external  influences,  the  growth 
of  hospitals  has  been  the  most  potent  of 
all  in  changing  the  practice  of  medicine.  Half 
a  century  ago,  there  was  but  one  large  hospital 
in  Boston.  Through  its  influence,  it  came  to 
pass  that,    since   no   fees   were   allowed   to   be 


Vol.  CLXXII,  Xo.  13] 


BOSTON  MEDICAL  AND   SURGICAL  JOURNAL 


475 


charged    by    its   physicians   and    surgeons    for 
the    care    of    its    inmates,    whether    rich    or 
poor,    some    of    its    medical    staff  established ! 
a  private  hospital,  in  which  they  could  receive ' 
remuneration  for  their  services.     I  mean  to  say ; 
that  this  was  a  local  influence.     General  influ- 
ences, however,  were  abroad  in  all  communities, ! 
which  led  to  a  demand  for,  and  the  increase  of,  | 
hospitals  of  every  grade.     We  might  say  that 
the  hospital  has  become  universal,  much  to  the 
detriment  of  the  medical  profession  pecuniarily, 
for  there  is  often  an  abase  of  charity,  since 
others  than  the  poor  habitually  seek  the  hos- ' 
pital,  and  deprive  the  doctor  of  his  pay.    This  is 
especially  the  case  among  those  who  come  and 
go  daily  in  the  out-patient  departments.    But  in 
the  wards  also  there  are  occasionally  wealthy 
patients,    some     of     whom     would     wish     t^i 
pay,  while  others  seek  to  escape  any  such  obli- : 
gation.     The   majority    of    doctors    are    placed 
somewhat  at  a  disadvantage  by  the  abundance 
of  hospitals,  and  perhaps  in  comparative  repu- 
tation with  the  physicians  who  hold  positions  in 
them.    Today  even  moderate  communities  have 
their  hospitals;  cities  many,  towns  or  villages 
one.     It  must  thus  be  evident  that  the  private 
physician,  surgeon,  and  even  specialist  have  the 
amount  of  their  business  decrea.sed  and  their 
earning  capacity  limited  by  hospitals.    It  is  not 
necessary  here  to  discuss  whether  the  public  are 
not  benefited  by  the  hospitals;  I  confine  myself 
to  their  influence  on  the  profession  of  medicine.    ] 

This  completes  my  enumeration  of  the  exter- 1 
nal  circumstances  which  have  influenced  the  pro- 1 
fession  of  medicine, 'and  we  now  turn  to  those 
changes  which  physicians  have  brought  about  i 
themselves.    Fifty  years  ago  Specialism  was  al- 1 
most  unknown  and  was  limited  to  the  special  \ 
senses,  as  the  eye  or  ear.    Gradually  specialties  i 
have  increased  more  and  more,  until  now  their 
divisions  and  subdivisions  are  so  minute  as  to  [ 
be    bounded    by    a    single    organ.      The    spe- 
cialist   justifies   his  position  by  saying  that  he 
knows  more  on  any  single  subject  by  confining 
himself  to   it.     The   family  practitioner,   how- 
ever, urges  that  the  specialist  loses  that  full 
consideration  of  the  general  well-being  of  the 
patient  which  he  himself  acquires.     It  is  cer- 
tainly unfortunate  that  the  doctor  does  not  have 
now  the  whole  of  his  patient,  and  that  the  pa- 
tient does  not  have  an  individual  doctor.     A 
large  family,  the  members  of  whieh  one  general 
practitioner  formerly  took  care  of,  knowing  by 
experience  their  heredity,  their  tendencies,  their 
habits,  now  seeks  the  advice  of  four  or  five  spe- 
cialists.    Apart  from  other  considerations,  ex- 
penses  are   thus  increased;  for   the   specialist, 
having  fewer  patients  and  fewer  calls  for  his 
services,  is  justified  in  charging  larger  fees. 

This  leads  us  to  say  a  word  of  what  has  been 
called  Commercialism  in  medicine.  This  I  un- 
derstand to  mean  thinking  more  of  the  fee  than 


the  patient  and  charging  all  that  the  patient 
can  pay.  I  wish  it  distinctly  understood  that 
no  one  is  more  particular  than  myself  in  charg- 
ing fees  to  patients  who  are  able  to  pay, 
provided  such  fees  are  reasonable,  and  we 
must  all  agree  that  the  very  rich  man  or  one  of 
social  prominence  should  be  charged  more  for 
skilful  service  than  his  neighbor  of  limited 
means.  But  very  large  sums  claimed  as  a  return 
for  professional  services  have,  as  I  believe,  in- 
jured the  reputation  of  the  profession.  The 
scandal  of  the  "split  fee"  I  have  never  per- 
sonally met  with. 

The  next  change  created  by  the  physicians 
tliemselves  is  Publicity.  The  reticence  of  the 
doctor  was  formerly  proverbial.  It  was  not 
deemed  wise  to  tell  the  patient  too  much.  Every 
medical  utterance  has  an  exaggerated  import- 
ance, and  an  opinion  too  freely  imparted  worries 
and  depresses  the  patient.  So  also  it  used  to  be 
thought  that  to  take  the  public  into  your  con- 
fidence and  to  communicate  the  "little  knowl- 
I'dge  which  is  a  dangerous  thing"  was  injurious; 
that  people  got  false  ideas  and  went  astray;  and 
that,  on  the  whole,  more  harm  than  good  was 
(ione.  Now  all  this  is  changed.  However,  when 
public  medical  lectures  are  confined  to  carefully 
selected  subjects  and  limited  to  hygienic  meas- 
ures, they  may  be  useful. 

Medicine  has  been  advanced  to  approximate  a 
Science  by  Laboratory  methods.  These  methods 
have  supplanted  the  guess-work  of  earlier  diag- 
nosis. They  are  invaluable ;  they  have  been  pro- 
duced gradually  by  patient  investigation  and 
self-sacrificing  and  sometimes  dangerous  labors; 
and  they  have  come  to  stay.  They  are  the  first 
line  of  defence  against  delusion  and  superstition 
in  medicine.  Moreover,  they  have  given  us  Pre- 
ventive Medicine.  In  my  earlier  days  there  was 
t)ut  one  disease  which  could  be  surely  averted, 
and  that  was  smallpox  by  the  use  of  vaccination. 
Now  the  discovery  of  serum-therapy  and  the 
injection  of  anti-toxins  control  diphtheria,  tem- 
jiorarily  control  typhoid,  and  offer  great  hope 
in  the  treatment  of  meningitis,  tetanus,  rabies, 
and  some  other  diseases  still  under  investiga- 
tion. No  greater  change  in  the  practice  of  medi- 
cine could  be  imagined. 

Finally,  the  Trained  Nurse  was  introduced 
among  the  sick  by  the  doctor  himself,  first,  in 
hospitals,  as  was  natural,  then  in  private  life. 
She  is  a  great  help  to  the  doctor;  she  relieves 
him  of  dnidgery;  she  lessens  his  anxiety;  she 
should  be  his  executive  assistant,  and  not  aspire 
to  be  his  partner.  She  should  be  modest  in  her 
dicta,  for  her  opinion  is  constantly  sought  and 
carries  weight.  While  in  acute  disease  her  full 
fees  are  no  more  than  they  should  be,  yet  in 
cases  of  long  illness  some  means  will  eventually 
be  found  by  which  the  very  heavy  expense  of 
her  service  may  be  diminished. 


476 


BOSTON   MEDICAL  AND   SURGICAL  JOURNAL 


[Apbil  1,  1915 


THE  MENACE  OP  SYPHILIS  TO    THE 
CLEAN  LIVING  PUBLIC. 

Bt  J.  Haepeb  Blaisdell,  M.D.,  Boston, 

Physician,  Skin  Department,  Boston  Dispensary ;  Der- 
matologist, Lynn  uospital;  Assistant,   Skin  De- 
partment, Massachusetts  General  Hospital. 

[From  the  Records  of  the  Skin  Department  of  the 
Boston  Dispensary.] 

Every  community  is  divided  into  two  classes 
of  individuals, — those  who  have  syphilis  and 
those  who  'are  exposed  to  it.  Medical  science 
and  lay  interests  have  been  focussed  upon  the 
diagnosis  and  successful  treatment  of  the  disease 
in  those  aflBicted  with  it  to  the  practically  total 
exclusion  of  the  now  greater  problem  of  the 
rights  and  protection  of  those  who  may  be  ex- 
posed to  it. 

Two  factors  enter  largely  into  the  present  in- 
difference on  the  part  of  the  physician  and  lay- 
man alike  to  the  relation  of  this  disease  to  public 
health.  One  is  th&  fact  that  syphilis  has  been 
and  always  will  be  closely  identified  with  im- 
moral sexual  relations.  The  acquisition  of  the 
disease  is  felt  to  be  but  a  just  punishment  for 
the  mis-deeds  of  its  possessor.  Blinded  by  the 
venereal  aspect  little  thought  has  been  given  to 
the  question  of  how  active  a  menace  it  may  be 
as  an  infectious  disease  to  the  general  clean  liv- 
ing public. 

The  second  factor  making  for  indifference  is 
that  we  are  absolutely  ignorant  as  to  the  prev- 
alence of  the  disease  with  which  we  are  fighting. 
An  approximate  number  even  of  those  having 
the  disease  in  this  Commonwealth  is  absolutely 
unknown.  Opinions  among  the  medical  profes- 
sion are  at  the  widest  variance.  One  extremist 
takes  the  lofty  attitude  that  such  a  disease  can- 
not be  present  among  the  high-class  clientele 
that  he  may  have.  Otherwise  broad-minded  phy- 
sicians frequently  rule  out  the  disease  for  no 
better  reason  than  "I  have  known  the  family 


for  years."  The  other  extremist  sees  the  spiro- 
chete at  the  bottom  of  every  puzzling  ease. 

For  several  years  past  syphilis  has  been  made 
a  reportable  disease  by  the  City  of  New  York 
and  the  figures  reported  by  the  health  authori- 
ties there  probably  represent  as  accurate  an 
estimate  of  the  amount  of  the  disease  in  a  given 
community  as  any  now  available.  During  the 
fourteen  weeks  from  July  4th  to  October  3d, 
1914,  25,633  infectious  and  contagious  diseases 
were  reported  in  the  City  of  New  York  with  a 
population  of  a  little  over  five  and  one-half  mil- 
lions. Syphilis  stood  first  in  the  list  with  6342 
cases  or  28% ;  tuberculosis  second,  5525  cases 
or  21%;  diphtheria  third,  3370  eases  or  13%; 
measles  fourth,  2750  eases  or  11%  ;  scarlet  fever 
fifth,  1064  cases  or  4%.  Figures  like  these  be- 
speak for  themselves  the  urgent  necessity  of  es- 
tablishing regulations  for  the  control  of  those 
having  the  disease  and  for  the  protection  of  the 
community. 

For  the  purpose  of  finding  out  how  definite 
a  menace  individual  cases  of  syphilis  may  be  to 
the  community,  sixty  cases  in  the  early  stages 
were  selected  as  they  happened  to  come  to  the 
Skin  department  of  the  Boston  Dispensary  and 
the  relation  of  their  infectiousness  to  their  as- 
sociates studied.  The  tabulations  include  sex, 
age,  marital  relation,  occupation,  duration  of 
the  disease  in  weeks,  presenting  symptoms, 
methods  of  living  and  eating,  the  number  of 
persons  exposed  through  coitus  since  infection, 
the  number  definitely  exposed  through  family 
life  or  association  in  boarding  houses,  the  num- 
ber of  co-workers  exposed;  and  the  number  of 
known  infections  from  the  case  in  hand.  The 
co-workers'  exposure  column  includes  only  those 
that  came  in  active  contact  with  the  infected  per- 
son through  toilets,  drinking  facilities,  etc.  No 
attempt  was  made  to  record  the  number  of  per- 
sons exposed  by  casual  contact  as  for  instance, 
— eating  in  the  same  restaurant,  being  waited 
on  in  a  store,  or  consuming  food  products 
handled  by  the  infected  person.  The  table  in 
full  with  a  more  detailed  explanation  of  some 
of  the  more  striking  cases  is  as  follows: 


w  > 


s 

s 

a 


■0.2 
2  > 


o   , 


1. 

M. 

21 

S. 

None 

6 

Primary 
No.  see. 

Home 

Home 

0 

10 

0 

0 

2. 

M. 

21 

s. 

Clerk 

14 

Primary 
Rash 
Mucous  p. 

Rooming 

Restaurants 
5 

6 

10 

50 

0 

3. 

M. 

21 

s. 

Shoe  worker 

3 

Primary 

Home 

Home 

5 

5 

— 

0 

4. 

M. 

20 

s. 

Printer 

4 

Primary 

Home 

Home 

5 

7 

— 

0 

5. 

F. 

20 

s. 

Clerk 

2 

Primary 

Home 

Home 

0 

4 

100 

0. 

6.    P.     39    M.   Home 


10 


Rash 
Mucous  p. 
Condylom. 


Home 


Home 


20 


7.    F.     37    S.    None 


Rash 
Mucous  p. 


Rooming 


Boarding  house  4 


18        — 


0 
~0" 
"0" 


8.    F.     24    S.    Cashier 


Primary  of 
Lower  lip 


Home 


Home 


20 


Vol.  CLXXII,  No.  13] 


BOSTON   MEDICAL  AND   SURGICAL  JOURNAL 


a 


9.     F.     19 


s. 


Candy 


Mucous  p. 
Condylom. 


a 
Home 


it 

a 
Home 


I 
6 
6 


26.    M.    19     S.     Machinist 


26 


27.    r.     24    S.    Nnrse 


Rash 
Mucous  p 
Alopecia 
"Rash 
Mncoos  p. 


Home 


Home 


Family 


Family 


81.     F.     42     M.    Home 


26 


82.    M.    49    M. 


Pnllman 
porter 


10 


Mucous  p. 
Rash 
jCondylom- 
Prlmary 
Rash 
Mncons  p. 


50 


80 


7        — 


Home 


Home 


Home 
Boardli« 
House 


Home 
Restaurant 


6       — 


86.    M.    22    S. 


Cook  In 
dairy 
lunch 


26 


86.    M.    20    S. 


Primary  of 
Finger 
Rash 
Mucous  p. 


Rooming 


Restaurant 


12        — 


Dish  washer      2 
In  restaurant 


Primary 


Rooming 


Restaurant 


16 


40.    F.     23    S.    Waitress 


14 


Primary 
Rash 
Mucous  p. 


Rooming 


Restaurant 


12 


477 


l5 


10. 

F. 

19 

S. 

Waitress 

20 

Rash 

Mucous  p. 
Condylom. 

Rooming 

Boarding  house  0 
Restaurant 

6 

40 

0 

11. 

M. 

28 

S. 

Electrician 

1 

Primary 

Home 

Home   ' 

0 

3 

— 

0 

12. 

M. 

27 

s. 

Printer 

8 

Primary 
Rash 

Home 

Home 

10 

6 

10 

0 

IS. 

M. 
M. 

84 

28 

s. 

Shoe 

16 

Rash 
Mucous  p. 
Condylom. 

Rooming 

Boarding  house 

2 

16 

8 

0 

14. 

M. 

Laborer 

8 

Primary 

Rooming 

Boarding  house  2 

6 

0 

0 

16. 

M. 

26 

s. 

Machinist 

12 

Muc.  patches 

Rooming 

Boarding  boose 

6 

6 

70 

0 

16. 

M. 

80 

8. 

Shoe 

26 

Rash 

Rooming 

Restaurant 

2 

14 

— 

0 

17. 

M. 

38 

S. 

Carpenter 

10 

Primary 

Rash 

Muc.  patches 

K(x>ming 

Boarding 
Restaurant 

2 

18 

— 

0 

18. 

M. 

81 

S. 

Chorus  man 

7 

Primary 
Rash 

Ilotcd 

Restaurant 

8 

— 

40 

0 

19. 

M. 

21 

S. 

Pool  room 

24 

Rash 

Muc.  patches 

Tongue 

Boarding 
house 

Restaurants 
3-4 

0 

10 

— 

0 

20. 

M. 

F. 

21 
87 

a. 
w. 

Messenger 

boy 
Candy 

6 
24 

Primary 

Rash 

Bash 

Mac.  patches 

Home 

Home 

0 

9 

16 

0 

21. 

Home 

Home 

0 

4 

— 

0 

22. 

M. 

16 

s. 

Actor 

12 

Primary  of 
Lip 
Mucous  p. 

Home 

Home 

0 

2 

0 

0 

23. 

M. 

20 

s. 

Teamster 

6 

Primary 

Home 

Home 

0 

6 

6 

0 

24. 

F. 

19 

s. 

Labor 

12 

Rash 
Mucous  p. 

Rooming 

Bestaormnts 
3-4 

0 

6 

— 

0 

26. 

r. 

82 

M. 

Labor 

7 

Rash 
Mucous  p. 

Rooming 

Boom 

8 

2 

0 

0 

0 
"0" 


28.    M.    20    S.    Clerk 

8 

Primary 

Home 

Home 

0 

8 

4 

6 

29.     M.    21    S.    None 

2 
9 

Primary 

Home 

Home 

0 

6 

— 

0 

80.    F.    SO    S.    Cook 

Primary 
Rash 

MOCOQS  p. 

Family 

Family 

0 

1 

0 

0 

88. 

M.    23    S.    liongshore 

24 

Rash 
Mucous  p. 

Rooming 

Boarding  honse  0 

8 

100 

0 

84. 

M.    18    S.    Machinist 

6 

Primary 
Rash 

Rooming 

Restaorants        2 

4 

7 

12 

0 

87. 

M. 

23 

S. 

Butcher 

4 

Primary 

Rooming 

Hotel 

0 

7 

16 

0 

88. 

F. 

85 

S. 

Labor 

14 

Rash 
Mucous  p. 

Rooming 

Restaurant 

8 

20 

— 

0 

89. 

M. 

18 

S. 

Drug  clerk 

8 

Primary 

Home 

Home 

8 

6 

2 

0 

478 


BOSTON   MEDICAL  AND   SURGICAL  JOURNAL 


[Apbii,  1,  1915 


1^ 


o 


41.     M.     23     S.     Mechanic 


14 


Primary 
Rash 


Rooming 


Restaurant 


=  .2 


42.     F.     21     S.     Clerk 


12 


Primary 
Rash  . 


Home 


Home 


43.  M.    24    S.    Clerk 

44.  M.    27     M.     Fruit 

hawker 


15 


Primary 
'Rash 
Mucous  p. 


Home 


Home 


Home 


Home 


20 


3        — 


45. 

M. 

24 

S. 

Elevator 

6 

Primary 

Home 

Home 

8 

4 

— 

0 

46. 

M. 

25 

S. 

Iron  worker 

7 

Primary 

Rooming 

Restaurant 

4 

25 

— 

0 

47. 

F. 

25 

M. 

Wife  of 
No.  44 

12 

Rash 
Mucous  p. 

Home 

Home 

1 

2 

0 

0 

48. 

M. 

23 

S. 

Mechanic 

8 

Primary 

Rooming 

Boarding 

2 

6 

30 

0 

49. 

M. 

30 

S. 

Cook 

8 

Rash 
Mucous  p. 

Rooming 

Restaurant 
5-6 

2 

7 

7 

0 

50. 

M. 

48 

s. 

Teamster 

16 

Primary 
Rash 
Mucous  p. 

Rooming 

Restaurant 

4 

16 

7 

0 

51. 

M. 

24 

s. 

Waiter 

9 

Primary 
Rash 
Mucous  p. 

Rooming 

Restaurant 
3 

0 

8 

— 

0 

52. 

M. 

25 

s. 

State  work 

3 

Primary 

Home 

Home 

2 

6 

— 

0 

53. 

M. 

28 

s. 

Actur 

4 

Primary 
Mucous  p. 

Rooming 

Restaurant 
2 

•2 

2 

0 

0 

54. 

F. 

24 

s. 

Saleslady 

? 

Wass.  ++  + 

Rooming 
with  No. 

Restaurant 
53                 2 

2 

2 

1 

1 

65. 

M. 

22 

s. 

Painter 

3 

Primary 

Home 

Home 

0 

6 

— 

0 

56. 

M. 

32 

s. 

Metal 
worker 

8 

Primary 
Rash 
Mucous  p. 

Rooming 

Restaurant 
2 

2 

10 

— 

0 

57. 

F. 

17 

s. 

None 

10 

Rash 

Mucous  p. 
Condylomata. 

Home 

Home 

3 

3 

— 

0 

58. 

M. 

26 

s. 

Tattooist 

1 

Primary 

Rooming 

Restaurant 

0 

3 

0 

0 

59. 

M. 

29 

M. 

Teamster 

6 

Primary 
Rash 

Mucous  p. 
Condylomata. 

Home 

Home 

2 

4 

2 

0 

60. 

F.28     S 

Boarding 
house  keeper 

4 

Primary 

of  tonsil 
Rash 

Boarding 

Boarding 

1 

25 

0 

0 

Case  6.  Married  woman.  Husband  away  for 
six  months  at  a  time.  Five  children  from  ages  of 
six  to  twenty  at  home.  Earned  extra  money  by  im- 
moral life  in  flat  up-stairs  kept  by  a  professional. 

Case  7.  Poverty  stricken  woman  of  subnormal 
intelligence  living  on  charity  and  occasional  im- 
moral earnings. 

Case  8.  Girl  of  good  family  with  primary  of  lip 
of  unknown  origin.  Was  having  occasional  inter- 
course with  fiance  who  neither  had  nor  contracted 
syphilis. 

Case  9.  Typical  "tough"  girl  working  in  a  candy 
factory  who  is  in  the  habit  of  having  promiscuous 
intercourse  with  her  male  friends.  Two  of  them 
not  recorded  in  this  series,  were  infected. 

Case  10.  Waitress  in  a  well  known  restaurant 
with  very  active  and  infectious  syphilis. 

Case  14.  Italian  laborer,  sleeping  with  another 
man,  who  planned  to  return  to  his  wife  and  two 
children  in  Italy  within  two  months.  I  know  of 
two  other  similar  cases  not  recorded  in  this  series. 


Case  21.  Woman  with  active  mouth  lesions  of 
syphilis,  who  worked  in  a  candy  factory.  Had  two 
small  children,  a  husband  and  a  lover. 

Case  22.  Actor  in  a  musical  comedy  show  with  a 
primary  of  the  lip  and  mucous  patches  who  was  in 
the  habit  of  kissing  many  of  the  chorus  girls  fre- 
quently. 

Case  27.  High  class  nurse  in  a  doctor's  family. 
Had  active  secondaries  before  the  trouble  was  dis- 
covered. Had  complete  charge  of  two  small  chil- 
dren and  was  treated  as  one  of  the  family,  eating 
at  the  same  table,  using  the  bath-room,  etc. 

Case  31.  Woman  with  very  active  sjrphilis  and 
several  "friends,"  who  infected  her  two-year  old 
baby  with  a  primary  of  the  forehead,  presumably 
from  kissing. 

Case  35.  Cook  in  a  dairy  lunch  place  with  a 
primary  of  the  finger  and  extremely  active  second- 
ary lesions  of  many  weeks'  duration.  This  man 
handled  all  the  food,  drinking  glasses,  dishes,  etc., 
of  a  great  many  people  daily.    His  infection  prob- 


Vol.  CLXXII,  No.  13] 


BOSTON   MEDICAL  AND   SVROWAL  JOURNAL 


479 


ably  came  from  some  dish  or  glass  used  by  a  syphi- 
litic. This  case  was  so  extreme  as  to  necessitate  its 
being  sent  to  the  State  Hospital. 

Case  38.  Young  woman  with  active  mouth  le- 
sions eating  in  the  dining  room  of  a  local  Y.  W. 
C.  A. 

Case  39.    Drug   clerk    with    active   lesions    who 


served  many  sodas  daily. 


Case  44.  Fruit  pedlar  who  had  relations  widi 
many  girls  to  within  one  week  of  marriage.  Wife 
showed  active  lesions  of  syphilis  and  was  pregnant. 

Case  45.  Elevator  boy  with  large  ulcerative 
primary  of  penis.  Had  had  relations  with  as  many 
as  eight  girls  since  date  of  infection  and  used  toilet 
in  common  with  about  300  people  in  the  oflSce  build- 
ing. 

Case  58.  Professional  tattooist  following  fairs. 
Denied  using  saliva  in  moistening  pigments  altho 
knew  of  its  being  done. 

Case  59.  Teamster  with  primary  and  all  the  sec- 
ondary manifestations  living  at  home  with  his  wife 
and  two  small  children.  He  could  not  be  prevailed 
upon  to  bring  them  in  for  examination  and  the 
case  was  soon  lost  sight  of. 

Case  60.  Woman  lodging-house  keeper  with  n 
primary  of  the  tonsil.  One  of  the  servants  in  the 
house  had  syphilis,  according  to  the  boarders. 
Woman  had  a  fiance  with  whom  she  had  been  in  the 
habit  of  having  occasional  intercourse  during  the 
past  year.  The  fiance  denied  all  syphilis  and  mar- 
ried the  woman  two  weeks  after  the  diagnosis  was 
made,  as  thoy  had  originally  planned  before  the  pri- 
mary appeared.  The  case  dropped  from  the  clinic 
and  the  source  of  the  syphilis  was  never  determined. 

These  sixty  cases  definitely  exposed  through 
coitus  from  the  time  of  their  infection  to  their 
first  appearance  in  the  clinic  for  treatment  one 
hundred  and  thirty-four  (134)  people.  Pour 
hundred  and  forty-two  (442)  others  were  com- 
ing in  contact  with  them  in  the  intimacies  of 
family  or  boarding-house  life.  Six  hundred  and 
fifty-one  C651)  fellow  workers  had  been  brought 
in  contact  with  them  sufficiently  to  run  a  defi- 
nite danger  of  contracting  the  disease. 

Of  these  sixty  cases  41  were  men  and  19  were 
women.  There  were  four  extra-genital  and  pre- 
sumably "innocent"  primaries,  the  number  be- 
ing evenly  divided  between  the  sexes.  One  wife 
contracted  the  disease  from  her  husband  and 
five  girls  were  infected  by  their  fiances.  Thirty- 
nine  of  the  men  and  eleven  of  the  women  ac- 
<iuired  the  disease  in  distinctly  immoral  ways. 

The  ages  of  the  patients  show  how  closely  the 
disease  is  associated  with  young  adults.  The 
youngest  patient  was  16,  the  oldest  48.  Eight 
men  and  five  women  contracted  the  disease  under 
20  years,  seventeen  men  and  six  women  between 
20  ad  25,  ten  men  and  two  women  between  25 
and  30,  and  six  men  and  six  women  after  their 
thirtieth  year. 

The  course  of  every  infectioiis  disease  may 


be  diagrammatically  represented  by  three  links 
of  a  chain.  The  patient  at  hand  corresponds  to 
the  middle  links,  with  the  source  of  his  infection 
being  the  first  link,  and  those  to  whom  he  passes 
the  disease  being  the  third.  The  stamping  out 
of  the  disease  depends  as  much  upon  the  prompt 
discovery  and  control  of  his  source  and  the  pre- 
vention of  his  possible  exposure  of  others  as 
upon  the  proper  medical  care  of  the  patient 
himself.  Generally  speaking,  either  in  hospital 
or  private  practice,  little  effort  is  being  made 
along  this  line.  This  series  strikingly  shows  the 
extent  of  the  present  neglect  and  how  vast  a 
field  of  preventive  medicine  is  still  untouched. 

These  sixty  cases  of  fresh  untreated  syphilis 
are  the  direct  result  of  sixty  other  definitely 
active  foci  of  infection  in  the  community.  Out 
of  these  sixty  foci  only  two  were  brought  under 
medical  care  and  control.  Of  the  576  people 
exposed  through  coitus  or  family  life  five  were 
known  to  have  been  infected, — four  through  in- 
tercourse and  one  by  being  kissed  by  the  mother. 
I  Of  the  571  equally  possible  infections  nothing 
is  known. 

The  danger  of  syphilis  to  the  community  as 
well  as  to  the  individual   is  incrca.scd   in  pro- 
portion to  the  inadequacy  of  the  treatment  re- 
ceived by  those  suffering  from  the  disease.    For 
the  purpose  of  finding  out  how  great  a  menace 
syphilitic  patients  are  to  themselves  and  their 
fellow-beings  through    neglected    treatment    a 
careful  statistical  investigation  of  this  portion 
'  of  the  clinic  was  made  in  order  to  find  out  how 
;  effectively  patients  follow  their  doctors'  advice. 
Every  visit  of  every  new  syphilitic  patient 
!  entering  during  the  twelve  months  beginning 
I  July  1,  1913,  has  been  tabulated  from  the  date 
I  of  entrance  to  September  1,  1914.    The  amount 
of  time  which  the    patients    might    have    been 
I  under  treatment  varies  from   fourteen   months 
I  for  those  who  entered  in  July.  1913.  to  three 
j  months  for  those  coming  to  the  clinic  last  June. 
1  The  table  showing  the  number  of  visits  that 
the  patients  of  the  various  months  of  entrance 
i  made  is  as  follows : 


i 

H 

1 

h 

1 

■s 

"Sfc 

6 

3 

t 

5H 

& 

i 

Ce. 

y. 

•^ 

a. 

c 

1 

(W 

.272 

58 

.288 

120 

.280 

2 

:« 

.162 

33 

.164 

71 

.158 

3 

31 

.124 

28 

.136 

59 

.130 

4 

32 

.128 

24 

.119 

50 

.124 

5 

18 

.072 

18 

.090 

36 

.080 

fi 

12 

.048 

10 

.049 

OO 

.048 

7 

10 

.040 

14 

.070 

24 

.054 

8 

8 

.032 

8 

.039 

16 

.036 

SM5 
1(V23 

26  -1 
8 

.132 

8 
0 

} 

.045 

33 

8 

"1 

J 

.090 

Total 

250 

1.000 

201 

1.000 

451 

IXKK) 

The  451  new  syphilitic  cases  of  the  year  were 
divided  into  164  primaries  and  very  early  cases, 
136  secondary  cases,  107  late  syphilitics. 
and    44     congenitals.      From     the     preceding 


480 


BOSTON   MEDICAL  AND   SUROWAL   JOURNAL 


[April  1,  1915 


table  it  will  be  seen  that  126  of  the 
451  patients,  or  28%,  came  only  once  to  the 
clinic.  Seventy  per  cent,  of  the  patients  made 
less  than  five  visits, — a  number  insufficient  in 
most  cases  to  relieve  even  the  presenting  symp- 
toms for  which  they  entered, — and  9%  only  came 
more  than  eight  times.  The  two  half-years  re- 
present two  different  medical  services,  and  it 
will  be  noticed  that  the  differences  in  the  pa- 
tients paying  one,  two,  three,  four,  and  five 
visits  are  negligible.  The  more  recent  service 
naturally  has  fewer  patients  paying  a  large  num- 
ber of  visits. 

The  attendance  of  the  451  patients  has  been 
analyzed  from  another  stand-point  to  show  the 
difference  between  the  visits  required  for  rela- 
tively good  treatment  and  the  number  that  they 
actually  made.  An  average  of  one  visit  every 
three  weeks  from  the  time  of  entrance  to  Sep- 
tember 1st  has  been  arbitrarily  selected  as  a 
minimum  measure  of  efficient  treatment.  Thus 
31  patients  coming  to  the  clinic  during  May 
theoretically  ought  to  have  made  an  average  of 
six  visits  apiece  during  the  four  months  to  Sep- 
tember 1st,  or  186  visits  for  that  group.  The 
table  in  detail  is  as  follows: 

Month  No.  of         Required  Actual  Percentage. 

Patients.  Visits,  Visits. 

July 45  945  234  .247 

August   55  1100  220  .200 

September   .    .  32  576  160  .278 

October 42  714  176  .246 

November  ....  36  540  153  .283 

December  ....  40  560  141  .252 

Total   250  4435  1084  .244 

January  33  396  107  .308 

February   ....  28  308  87  .282 

March 36  324  127  .392 

April  31  248  130  .524 

May    31  186  115  .618 

.Tune   42  210  145  .690 

Total  201  1672  711  .425 

Grand   total  451  6107  1795  .294 

During  the  months  from  July,  1913,  to  De- 
cember, 1913,  inclusive,  250  new  cases  of  syph- 
ilis visited  the  clinic.  On  the  bases  referred  to 
4435  visits  ought  to  have  been  made  by  these 
patients.  Actually  1048  were  made  or  24.4% 
of  the  required  number.  This  percentage  re- 
mained fairly  constant  throughout  the  period, 
the  variations  among  the  six  months  being  only 
between  20%  and  28%. 

During  the  six  months  beginning  January, 
1914,  and  closing  June  30  there  were  201  new 
cases  of  syphilis  who  up  to  the  close  of  Sep- 
tember should  have  paid  on  the  basis  assumed 
1672  visits.  Actually  711  visits  were  paid  or 
421/2'%-  The  percentages  show  interesting  in- 
creases during  the  more  recent  months  as  fol- 
lows: January,  30.8%;  February,  28.2%; 
March,  39.2%;  April,  52.4%;  May,  61.8%; 
June,  69.0%. 

Summarizing  the  two  half  years  it  was  found 
that  during  the  twelve  months  beginning  July 


Ist,  1913,  the  451  cases  should  have  paid  6107 
visits  to  the  clinic  up  to  the  close  of  August. 
Actually  1795  visits  were  paid  or  29.4%  of  the 
needed  number. 

The  explanation  of  the  increasingly  better  at- 
tendance during  the  recent  months  is  a  simple 
one.  During  the  first  three  months  after  be- 
ginning treatment  a  considerable  portion  of  the 
patients  come  regularly,  one-half  or  more  paying 
the  number  of  visits  needed  during  this  period, 
^fter  the  first  three  months,  when  symptoms 
may  be  relieved  but  cure  cannot  have  been  ef- 
fected, patients  return  much  less  regularly. 
After  the  first  few  months  the  clinic  averages 
only  25%  of  the  visits  required  for  minimum 
efficient  treatment. 

SUMMARY. 

1.  The  amount  of  syphilis  in  Massachusetts 
today  is  absolutely  unknown.  Figures  from  com- 
munities where  the  disease  is  reportable  show  it 
to  be  one  of  the  two  most  prevalent  infectious 
diseases  with  which  we  are  fighting. 

2.  Every  syphilitic  case  definitely  exposes 
many  innocent,  clean  living  people  to  the  dis- 
ease. Sixty  cases  of  fresh  syphilis  exposed  134 
by  coitus,  442  by  family  or  boarding-house  life, 
and  651  by  occupational  association, — 1227  peo- 
ple in  all. 

3.  At  present  no  organized  effort  is  being 
made  to  round  up  the  source  of  every  case.  Out 
of  the  sixty  sources  of  this  series  only  two  were 
brought  under  medical  care.  These  sixty  cases 
infected  at  least  five  others,  but  no  effort  was 
made  to  trace  out  infections  in  over  five  hundred 
equally  good  possibilities. 

4.  Left  to  themselves,  patients  make  little  ef- 
fort to  follow  up  even  the  most  elementary 
treatment. 

5.  Twenty-eight  per  cent,  of  the  patients  en- 
tering the  clinic  with  active  symptoms  of  syph- 
ilis never  return  for  treatment. 

6.  Seventy  per  cent,  made  less  than  five  visits, 
— a  number  insufficient  in  most  cases  to  relieve 
the  presenting  symptoms  for  which  they  entered. 

7.  After  the  first  few  months  the  syphilitic 
patients  as  a  whole  average  only  25%  of  the 
visits  required  for  minimum  efficient  treatment. 


AN  UNDESCRIBED  ULNAR  NERVE  TROU- 
BLE, DUE  TO  TENSION  FROM  SCAR, 
AND  ITS  CURE. 

By  F.  J.  Cotton,  A.M.,  M.D.,  P.A.O.S.,  Boston. 

From  observations  of  the  last  three  years,  I 
have  come  to  regard  as  a  separate  class  (ap- 
parently unrecognized  hitherto)  lesions  of  the 
ulnar  nerve  at  the  elbow,  due  to  the  intermittent 
tension  produced  by  elbow  motion  on  a  nerve 


Vol.  CLXXII,  No.  13] 


BOSTON   MEDICAL  AND   SOBGIOAL  JOURNAL 


481 


held  rigidly  fixed  by  deep  scar.  Compression 
lesions  of  nerves,  associated  with  fractures,  we 
all  recognize,*  but  this  is  a  different  story.  Not 
all  these  cases  have  had  any  fracture  at  all,  and 
iione  of  them  any  compression  of  the  nerve,  even 
by  scar,  so  far  as  could  be  determined. 

The  mechanism  is  purely  fixation  of  the  nerve 
by  scar  tissue,  at  the  turn  of  the  elbow,  where 
it  lies  in  the  epitrochlear  groove,  or  in  the  inch 
next  below  this  point.  Given  a  nerve  so  fixed, 
it  must  necessarily  happen  that  flexion  of  the 
elbow  must  pull  upon  it,  and  ordinary  use  of 
the  arm  must  give  intermittent  traction  on  the 
nerve  trunk.  The  result  may  be  (see  cases  to 
follow)  in  some  measure  a  paresis  in  the  muscles 
supplied  by  the  nerve,  sometimes  with  marked  ! 
atrophy  in  the  muscles  of  the  hand,  but  more 
particularly,  the  damage  expresses  itself  in  pain ; 
pain  radiating  from  the  elbow  down  to  the  last 
two  fingers,  witli  numbness  to  touch  in  this  re- 
gion; a  numbness  not  usually  serious  in  itself, 
hut  important  as  an  indication  of  real  trouble. 

Pain  and  a  partial  paresis  of  the  intrinsic 
muscles  of  the  liand,  expressed  in  weakness  and 
clumsiness  in  executing  the  liner  movements  of 
the  fingers,  are  the  factors  which  principally 
form  the  list  of  complaints  from  the  patient. 
Relief  of  this  condition  is  surgical.  Just  as  in 
the  cases  of  intermittent  nerve-pressure  symp- 
toms from  recurrent  luxation  of  the  nerve  at  the 
elbow,' — so  here  also,  the  only  remedy  is  removal 
of  the  nerve  to  a  more  favorable  site ;  we  can 
relieve  symptoms  by  dissecting  out  the  nerve, 
carrying  it  forward  and  imbedding  it  in  loose 
fat  and  muscle. 

The  case  histories  tell  the  story  fairly  well, 
though  the  records  leave  something  to  be  de- 
sired. 


Case  1.  W.  H.;  seen  Oct.  80,  1912  for  Dr.  J.  B. 
Murphy  of  Taunton,  Mass.  He  had  an  olecranon 
fracture  which  is  said  to  have  united  in  the  ex- 
tended position  with  stiffening  of  the  elbow.  The 
elbow  is  then  said  to  have  been  broken  up  under  an 
anesthetic,  and  put  up  at  a  right  angle.  When  I 
saw  him  first,  the  elbow  was  rigid  at  135  degrees, 
and  very  sensitive.  There  was  much  muscle  atro- 
phy, both  above  and  below  the  elbow,  and  consider- 
able stiffness  of  wrist  and  finger  motion.  There  had 
been  no  recent  improvement.  I  therefore  proceeded,  I 
Nov.  4,  1912,  to  mobilize  the  joint  under  anesthesia.  [ 
After  this  he  had  the  usual  treatment  by  exercises  ' 
and  massage,  and  did  more  than  usually  well,  so  far 
as  regaining  of  elbow  motion  went.  By  the  follow- 
ing spring,  he  had,  by  persistent  effort  aided  by  mas- 
sage, regained  motion  in  flexion  to  about  ten  degrees 
beyond  a  right  angle,  and  something  near  fifty  de- 
grees of  extension,  with  free  rotation  and  free  wrist 
motion,  and  with  only  a  little  stiffness  of  the  fingers. 
When  I  next  saw  him,  a  little  less  than  a  year  after 
his  first  visit,  the  condition  had  changed  notably. 
Motion  and  strength  were  improving  slowly,  but  he 
again  had  severe  pain,  no  longer  general  about  the  i 

•  Such  lesions  for  instance  are  described  in  connection  with  epi- 
trochlear fracture  and  displacement  of  the  fragment  into  the  Joint, 
giving  nerve  comprension  by  tension  on  the  intact  periosteal  at- 
tachments. Cotton,  "Dislocation  and  Joint  Fractures."  Saunders. 
IBIO,  p.  218. 

'Cotton:     Boston  M«d.   axo  Sueo.  Jooh.,  Vol.  cxiiii,  p.  in.      i 


joint,  but  localized  to  the  inner  side  and  radiating 
down  to  the  last  two  fingers,  increased  by  use  of  the 
arm,   intermittent  and  pretty   severe.     There   was 
thickening  all  about  the  elbow,  as  there  always  had 
been.    On  examination,  there  was  thickening  in  the 
I  epitrochlear  groove;  well  marked,  though  reference 
{  to  the  x-rays,  previously  taken,  showed  no  epitroch- 
I  lear  damage.    Closer  study  of  the  elbow  showed  the 
nerve  easily  palpable  just  above  the  groove,  appar- 
;  ently  slightly  thickened  and  abnormally  sensitive. 
There      was      hyperesthesia     of     the      skin      area 
supplied    by    the    ulnar;    there    was    decided    loss 
of    power     in     the     hand     muscles    supplied     by 
the     ulnar;     movements     of     the     fingers     were 
clumsy;   there  was  some   wasting  of  the  intrinsic 
muscles  of  the  hand.     It  required  little  ingenuity 
to   reconstruct   the  story.     The   ulnar   nerve,   em- 
bedded in  the  scar  tissue  that  was  all  about  the 
joint,  was  constantly  pulled  on  in  the  persistent  ex- 
ercises used  to  limber  the  joint.     The  scar  tissue 
had  not  compressed  it  at  all,  but  had  fixed  it    Pro- 
tected  while   the   arm   was   stiff,   the   bound-down 
nerve  was  injured  by  the  return  of  joint  motion.    1 
advised  operation,  but  the  patient  postponed  it,  in 
view  of  pending  litigation,  and  later,  depressed  over 
the  loss  of  his  suit,  declined  intervention.    He  had, 
however,  carried  out  the  lighter  regime  1  had  pre- 
scribed pending  operation,  and  when  1  last  saw  him 
in  March,  1914,  the  condition  was  improved  as  to  all 
nerve  symptoms,  though  by  no  means  normal. 

Case  2.  A  young  boy,  seen  in  consultation.  El- 
bow injury  of  some  months'  duration;  no  fracture. 
Pain  on  use  of  the  arm,  felt  at  the  elbow,  running 
[  down  to  the  fourth  and  fifth  fingers;  partial  loss  of 
power;  some  atrophy;  some  tilling-up  of  the  epi- 
trochlear groove.  Diagnosis  made  of  condition 
similar  to  that  in  Case  1.  When  operated  upon,  no 
nerve  compression  was  found.  The  nerve  was,  how- 
ever, surrounded  and  held  by  scar  tissue.  The  sur- 
geon operating  considered  the  exploration  negative 
and  did  nothing  more.    Result  unknown  to  me. 

Casi  8.  1.  B.;  seen  July  31,  1913.  Q' .i  bf  18; 
referred  to  me  by  Dr.  J.  H.  Sweet,  .1  .,  of  Taunton. 
History  of  a  blow  on  the  right  p'Low  two  or  three 
years  ago.  Lameness  of  the  jIuOw  for  a  time;  then 
it  grew  better,  but  not  ':ug  after  this  it  grew  bad 
again  and  from  tiir  to  time  has  given  much  pain 
and  trouble.  Sh  has  struck  the  elbow  two  or 
three  times  since  then.  The  elbow  shows  no  sign  of 
previous  fracture  or  luxation.  There  is,  however, 
distinct  thickening  in  the  epitrochlear  groove,  and 
the  nerve  just  above  this  point  is  sensitive.  Pres- 
sure on  the  nerve  gives  tingling  pain  down  the  arm, 
and  sharp  flexion  of  the  elbow  gives  like  pain.  There 
is  decided  clumsiness  in  motions  of  the  hand,  and 
moderate  atrophy  of  the  intrinsic  muscles  of  the 
hand;  there  is  definite  and  considerable  hyperesthe- 
sia over  the  ulnar  area ;  there  is  an  abnormal  smooth 
look  to  the  hand,  and  a  definite  beginning  of  the 
"main  en  griffe"  attitude.  There  have  been  ulcera- 
tions about  the  nails  of  the  last  two  fingers,  obvious- 
ly "trophic."  Operation  advised  and  carried  out 
Aug.  9,  1913.  Incision  on  the  inner  side  of  the  el- 
bow down  onto  the  ulnar  nerve  showed  it  a  bit 
thick  above  the  joint.  At  a  level  just  above  the 
epicondyle,  it  disappeared  downward  into  a  mass  of 
fairly  dense  fibrous  tissue,  to  which  it  was  every- 
where adherent,  though  nowhere  compressed.  The 
nerve  had  to  be  dissected  out  for  over  an  inch  of  its 
length.     Below  this  point,  it  was  free  and  normal. 


482 


BOSTON   MEDICAL  AND   SVRQWAL  JOURNAL 


[Apkil  1,  1915 


The  nerve  was  lifted  from  its  bed,  carried  well  for- 
ward of  the  condyle,  and  laid  in  a  groove  of  fat 
and  superficial  fascia,  which  was  lightly  stitched 
about  it.  The  wound  was  then  sewed  and  the  arm 
put  up  at  right  angles.  The  next  day  sensation  had 
become  approximately  normal,  and  the  fingers  were 
better  handled  and  felt  more  normal  to  her.  Im- 
provement within  three  days  was  startlingly  rapid. 
She  went  home  then,  but  reported  in  nine  days  with 
an  arm  and  hand  normal,  except  for  incomplete  re- 
pair of  muscle  atrophy.  At  forty  days  she  wrote  of 
the  arm  as  normal,  except  for  some  tremor  of  the 
hand  after  writing.  Three  weeks  later  she  fell  down 
stairs,  and  had  some  return  of  pain  at  the  elbow  but 
no  motor  disturbance.  Since  then  I  had  no  news  of 
her  until  Dec.  23,  1914,  when  she  wrote  in  response 
to  my  letter  of  inquiry  to  the  effect  that  the  hand 
was  normal,  save  for  some  "hurt"  after  "using  it 
hard  or  long."  She  is  in  school,  writing  with  this 
hand.  She  writes  that  there  have  been  two  "sores," 
since  I  saw  her,  so  evidently  the  operation,  while 
very  serviceable,  was  not  an  absolute  cure. 

Case  4.  E.  McC,  aged  12  years.  Came  to  me, 
referred  by  Dr.  Charles  H.  Hare,  Jan.  28,  1914. 
She  had  broken  her  right  elbow  early  in  September, 
1913,  in  a  distant  town:  The  fracture  was  reduced ; 
put  up  in  splints,  then  in  plaster,  to  Oct.  12,  1913; 
later  subjected  to  passive  motion  of  the  usual  sort, 
once  under  an  anesthetic.  The  patient  was  a  tall, 
slight,  but  vigorous  girl,  who  showed  nothing  of  in- 
terest save  the  right  arm,  which  was  carried,  help- 
less, at  her  side.  The  hand  was  shiny-skinned  and 
smooth;  the  fingers  were  held  in  the  main-en-griffe 
attitude.  The  muscles  of  the  hand  innervated  by 
the  ulnar  nerve  were  all  wasted,  and  their  action 
weak  and  uncertain.  There  was  very  definite 
though  incomplete  sensory  loss  in  the  region  of  the 
ulnar  supply.  There  was  much  radiating  pain  in 
the  ulnar  supply,  increased  by  attempted  use  of  the 
hand.  Besides  this,  however,  there  was  distinct  loss 
of  power  and  a  trace  of  dulling  of  sensation  in  all 
the  muscles  and  the  skin  surface  helonging  to  medi- 
an and  radial  nerves  below  the  elbow.  Obviously  we 
were  dealing  in  part  with  the  results  of  a  compres- 
sion-lesion, due  to  fracture  or  reduction,  or  more 
likely,  to  splint-compression.  There  was,  however, 
distinct  thickening  about  the  ulnar  nerve  in  the 
groove  under  the  epitrochlea.  Evidently  the  frac- 
ture had  been  supracondylar;  position  and  motion 
at  the  elbow  were  excellent.  I  sent  her  to  Dr.  J.  W. 
Courtney  for  a  neurological  opinion,  and  he  found 
the  ulnar  nerve  most  affected,  and  advised  operation 
on  the  chance. 

Jan.  30,  1914,  I  operated.  Again  the  nerve  lay  in 
a  mass  of  scar;  again  it  was  dissected  out,  swung 
forward,  and  imbedded  in  a  roll  of  fat,  and  stitched 
in  place.  Within  three  days,  improvement  was 
marked.  The  hand  was  warmer;  the  fingers  more 
responsive;  the  pains  less.  Improvement  was  steady, 
and  as  the  ulnar  nerve  supply  returned  to  normal, 
so  also  did  the  muscles  of  the  median  and  musculo- 
spiral  groups,  though  these  nerves  were  not  touched. 
June  16,  1914,  she  was  discharged  apparently  well 
in  every  way,  as  to  freedom  from  pain,  and  as  to 
muscle  function  and  sensation. 

Case  5.  J.  W.  B.;  referred  to  me  by  Dr.  G.  P. 
Laton  of  Salem,  N.  H.  Seen  July  14,  1914;  age,  55; 
height,  5  feet,  10 V2  inches;  weight,  195  pounds;  oc- 
cupation, carpenter.  History  of  injury  was,  that  in 
car  derailment  April  12,  1914,  he  was  thrown  fifteen 


feet  or  so,  landing  on  the  right  side,  shoulder,  and 
elbow.  He  shows  a  typical  picture  of  subdeltoid 
bursal  adhesions,  but  also  the  picture  of  ulnar  nerve 
involvement;  a  little  dulling  of  sensation  in  the 
last  two  fingers;  muscle  action  within  the  ulnar 
supply  very  defective;  considerable  atrophy  of 
muscle  in  the  thenar  and  hypothenar  eminences  and 
in  the  substance  of  the  palm.  There  was  definite 
thickening  below  the  epitrochlea;  a  thickening  into 
which  the  large  but  not  abnormally  thickened  or 
sensitive  ulnar  nerve  disappears.  He  was  treated 
with  baking  and  massage  for  three  months,  without 
improvement.  The  notes  of  the  operation  are  as 
follows : 

Operation  Oct.  22,  1914,  Scobey  Hospital.  Inci- 
sion in  right  arm,  over  epitrochlea,  and  about  four 
inches  above  and  below;  ulnar  nerve  dissected  out 
of  its  bed.  From  about  half  an  inch  above  the  epi- 
trochlea, it  is  normal  in  appearance  and  in  sur- 
roundings ;  below  this  point,  the  nerve  is  surrounded 
by  a  good  deal  of  rather  dense  scar  tissue,  making 
a  very  definite  sheath,  out  of  which  the  nerve  could 
be  lifted  only  after  dissection  of  adhesions.  As 
usual  there  was  no  compression  of  the  nerve  at  any 
point,  the  nerve  trunk  appearing  rather  thicker  and 
perhaps  a  trifle  pinker  than  normal.  Nerve  car- 
ried, after  this  dissection,  clear  of  the  epicondyle  in 
front,  and  stitched  down  in  a  bed  of  fat,  fascia  and 
muscle,  coming  back  to  its  normal  course  in  a  mass 
of  fat  above,  in  the  mass  of  pronator  muscle  below. 
Eight  shoulder  manipulated  with  the  breaking  of 
two  distinct  adhesions,  one  of  which  gave  way  in 
abduction,  and  the  other  in  internal  rotation.  Arm 
then  showed  full  normal  motion;  put  up  in  plaster 
in  abduction  and  in  more  than  the  usual  outward 
rotation.    Much  pain  on  recovery,  in  shoulder  only. 

Dec.  15,  1914.  Hand  looks  entirely  normal;  use 
normal.  The  only  thing  left  in  regard  to  the  ulnar 
nerve  is  a  slight  sensitiveness  where  the  nerve 
crosses  the  elbow,  in  its  new  position,  when  he  tries 
to  use  a  screw  driver  hard,  and  a  trace  left  of  the 
atrophy  of  the  ulnar  side  of  the  forearm;  a  hardly 
perceptible  trace.  Muscles  of  the  hand  have  already 
regained  almost  their  normal  bulk.  The  shoulder 
shows  slight  improvement ;  less  painful,  and  range  of 
motion  is  increased  a  little.  I  do  not  think  the 
present  condition  warrants  the  advisability  of  fur- 
ther interference.  He  is  to  go  ahead  with  exercises, 
as  usual,  but  not  very  strenuously,  and  is  to  report 
about  the  first  of  the  year. 

Jan.  5,  1915.  Hand  entirely  normal,  except  for  a 
trace  of  the  atrophy  of  the  muscle  in  the  hand;  use 
of  it  entirely  normal.  Shoulder  progressing  in  use- 
fulness, but  a  bit  slowly. 

Case  C;  F.  E.  A.,  seen  Oct.  2,  1914,  for  the  In- 
dustrial Accident  Board.  He  is  a  painter  and  dec- 
orator; age  57  years.  Medical  history  of  no  inter- 
est up  to  an  accident  sustained  Aug.  30,  1913,  when 
he  fell  with  a  staging  about  ten  feet,  striking  his 
left  arm  as  he  fell.  He  was  under  hospital  treat- 
ment for  ten  days.  For  over  a  year,  no  treatment 
save  massage  and  liniments,  and  with  no  substantial 
improvement.  He  complains  of  loss  of  power  in  the 
hand  and  of  numbness.  The  left  elbow  showed 
slight  limitation  of  extension;  marked  thickening 
about  the  inner  side  of  the  elbow.  Atrophy  of 
muscles  in  the  ulnar  supply  not  extreme,  but  they 
show  partial  loss  of  power  and  there  is  a  very  defi- 
nite clumsiness  in  executing  the  finer  motions  of  the 
hand.  There  is  definite  partial  anesthesia  of  the 
third  and  fourth  fingers.    In  this, case,  the  thicken- 


Vol.  CLXXII,  No.  13] 


BOSTON   MEDICAL   AND   SUROWAL  JOURNAL 


483 


ing  at  the  elbow  was  so  marked  that  a  diagnosis  of 
epitrochlear  fracture  could  be  made  definitely. 

He  was  later  sent  to  me  by  Mr.  H.  Edsall  of  the 
General  Accident  Co.,  with  a  view  to  repairing  dam- 
age, and  on  Oct.  24,  1914,  1  operated  at  the  Scobey 
Hospital.  Incision  showed  the  ulnar  nerve  embed- 
ded below  the  elbow  in  a  tough  fibrous  mass,  so  hard 
that  it  "whistled"  when  cut.  This  extended  for  a 
little  distance  above  and  for  about  three-fourths  of 
an  inch  below  the  epitrochlea.  The  nerve  was  solidly 
adherent  all  through  this  region,  but  when  dissected 
'  out,  was  not  itself  in  any  way  abnormal.  The  nerve 
in  this  region  and  for  three  inches  above  the  elbow, 
though  normal,  was  a  large  ulnar  nerve.  Dissection 
carried  down  into  the  flexor  muscle  mass.  After  the 
nerve  had  been  cut  out  of  the  groove  at  the  back  of 
the  condyle,  investigation  showed  the  fragment  felt 
at  examination  to  lie  directly  below  the  epicondyle, 
and  between  it  and  the  place  where  the  nerve  lay 
was  only  fibrous  tissue;  a  piece  of  the  bone,  one-half 
to  five-eighths  of  an  inch,  was  removed  without 
opening  the  joint.  The  nerve  was  transplanted  for- 
ward into  a  very  satisfactory  bed  of  fat,  covering  it 
un  both  sides.    Arm  put  up  at  right  angles  in  sling. 

Nov.  4,  1914.  Still  shows  a  trace  of  the  muscle 
atrophy  previously  present,  but  muscle  power  every- 
where is  good;  can  spread  his  fingers  perfectly  well, 
etc.  The  partial  anesthesia  of  which  he  complained 
has  entirely  disappeared;  feeling  the  same  in  these 
two  fingers  as  in  the  others ;  as  he  expresses  it  "life 
has  come  back  into  the  hand."  Now  shows  nothing 
excepting  the  scar,  and  the  slight  thickening  in  the 
bend  of  the  elbow,  where  the  fact  was  rolled  up  to 
make  a  bed  for  the  nerve. 

When  last  seen,  Nov.  23,  1914,  he  showed  a  hand 
in  all  respects  normal  save  for  a  trace  of  the  muscle 
atrophy.  Sensation  was  perfect  and  the  coordina- 
tion of  the  finer  movements  of  the  hand  entirely 
restored. 

Case  7.  J.  S.,  teamster,  aged  46  years;  seen  Nov. 
20,  1914,  for  Mr.  H.  Edsall.  He  says  that  on  the 
day  after  Thanksgiving,  1913,  he  was  sitting  on  his 
team,  when  the  horses  started  suddenly.  He  lost  his 
balance  and  fell  on  his  right  elbow.  Went  to  the 
City  Hospital,  and  was  treated  with  the  arm  in  a 
sling  in  a  flexed  position  for  three  months,  according 
to  him.  An  x-ray  was  taken.  Later,  was  treated  at 
Tewksbury,  and  here  also  an  x-ray  was  taken.  He 
proved  to  be  a  vigorous  sort  of  a  man,  looking  less 
than  his  age.  The  right  elbow  showed  limitation  of 
about  25  degrees  in  extension;  a  little  less  in  flexion 
and  rotation.  The  limitation  was  purely  a  loss  of 
mobility,  not  painful.  (Later  examination  of  the 
early  x-rays  at  the  Boston  City  Hospital  showed 
nothing  but  a  moderate  articular  thickening  of  the 
sort  one  finds  in  laboring  men  of  middle  age.)  More 
interesting  was  the  loss  of  power  in  the  muscles  of 
the  hand,  and  the  trace  of  anesthesia  in  the  region 
supplied  by  the  ulnar  nerve.  There  was  also  some 
stiffening  of  the  fingers,  due  in  my  opinion,  partly, 
like  the  elbow  stiffness,  to  overlong  fixation ;  partly 
to  defective  power  in  the  muscles  that  should  have 
been  limbering  up  the  fingers  during  the  past  year. 
The  hand  muscles  were  a  good  deal  wasted.  The 
condition  had  been  stationary  for  some  months  at 
least.  Below  and  behind  the  elbow,  in  this  case  as 
in  the  others,  was  a  very  definite  thickening  into 
which  the  nerve  disappearai  downward.  I  advised 
operation  and  operated  Dec.  16,  1914.  Incision  just 
behind  epicondyle,  five  inches  long.  Ulnar  nerve 
found  firmly  bound  to  a  point  above  the  epicondyle; 


very  firmly  aderent  in  dense  scar  mass  which  was 
in  this  instance  not  very  thick  but  rigid  and  tough. 
Same  operation  done  as  in  the  other  cases,  imbed- 
ding the  nerve  in  fat,  in  this  instance  for  the  entire 
length  of  its  new  course.  Nerve  in  this  case  could 
not  be  carried  quite  as  far  forward  as  the  others, 
but  well  clear  of  the  condyle.  The  motion  of  the 
elbow  was  no  freer  under  ether,  and  attempts  at 
stretching  it  met  with  definite  fibrous  resistance, 
not  to  be  overcome.    Usual  dressing. 

In  this  case  also  there  was  within  three  days  a 
subjective  improvement  and  within  a  week  the  anes- 
thesia was  all  gone  and  the  fingers  could  be  handled 
better. 

Jan.  5,  11)15,  examination  showed  definite  im- 
provement in  regard  to  the  atrophy  of  muscles; 
firmer  grasp;  good,  practically  perfect,  coordination 
in  the  finer  movements  of  the  hand;  and  most  en- 
couraging of  all,  real  improvement  in  the  range  of 
flexion  of  the  fingers.  The  condition  at  the  elbow, 
as  regards  motion,  does  not  show  any  change. 

Jan.  19,  1915.     No  pain;  very  definite  improve- 
ment in  motion  of  lingers  and  in  wrist  motion.  Fin- 
gers handled  much  better. 
) 

Despite  minor  differences,  these  cases  clearly 
belong  in  a  class  by  themselves, — a  class  not  appar- 
ently recognized  in  the  previous  literature.  The 
conditions  found  at  operation,  together  with  the 
surprisingly  abrupt  relief  of  anesthesia  (and  of  pain, 
in  case  it  had  been  present  previously)  and  the  very 
rapid  improvement  in  motor  function,  with  prompt 
rebuilding  of  atrophic  muscle,  all  lead  me  to  class 
these  as  lesions  due  to  the  constant  irritation  of  the 
fixed  nerve  by  flexion  and  extension  moven>cnts, 
rather  than  as  compression  lesions. 

Perhaps  my  haviug  seen  so  many  of  these  cu- 
rious cases  in  a  short  period  may  be  only  a 
chance,  but  1  cannot  lielp  suspcetiug  that  this 
lesion  may  often  liave  been  unnoticed  as  well  as 
undescribed.  The  resultant  disability  is  not  in- 
considerable, and  it  behooves  us  to  keep  an  eye 
open  for  these  cases — if  for  no  other  reason,  be- 
cause they  are  so  easily  cured,  and  so  quickly. 


SOME  NERVOUS  AFFECTIONS  IN  WHICH 
MASSAGE  DESERVES  MORE  FRE- 
QUENT USE.* 

IlY  .7.  W.  Courtney,  M.D.,  Roston. 

That  massage  is  an  important  therapeutic  fac- 
tor has  long  sine*-  been  an  established  fact. 
Whether  or  not  it  holds  a  position  as  promi- 
nent as  it  desei^'es  in  the  therapy  of  nervous  dis- 
orders is  debatable.  The  (|uestioii  is  one  which 
I  shall,  ill  this  brief  communication,  not  at- 
tempt to  settle.  I  shall  content  myself  with 
pointing  out  to  you  certain  nervous  disorders  in 
which  massage  in  some  form  might  with  benefit 
be  more  frequently  employed. 

In  the  rather  large  group  of  myospasms  there 

*  Paper  read  before  the  Manachusetto  Therapeutic  Uitmgt  Aian. 
ciation,  January  12,  1015, 


484 


BOSTON   MBDIOAL  AND   SUROWAL  JOVRNAL 


[Apbil  1,  1815 


are  two  varieties  peculiarly  rebellious  to  drug 
treatment.  One  of  these  you  probably  know  un- 
der the  name  of  wry -neck,  the  other  as  writer's 
cramp — a  disorder  by  no  means  confined  to  pen- 
men, but  found  also  among  typists  and  among 
artisans  whose  occupations  demand  an  incessant 
abuse  of  the  coordinated  movement  of  the 
smaller  muscles  of  fingers  and  hands. 

In  the  wry-neck  variety  of  myospasm  I  am 
thoroughly  satisfied  that,  in  most  eases,  the  seat 
of  the  trouble  is  to  be  found  in  the  cortex  of  the 
brain.  I  hold  this  belief  for  two  reasons:  first, 
because  of  the  absolute  inefficacy  of  local  sur- 
gery as  a  curative  measure ;  and  second,  because 
of  the  relief  sometimes  obtained  in  the  spas- 
modic cases  through  the  effect  produced  upon  the 
mind  by  a  supposed  operation.  In  two  cases  of 
very  long  standing  which  came  under  my  ob- 
servation a  few  years  ago.  Dr.  Bottomley,  at  my 
suggestion,  excised  fairly  large  pieces  of  the 
nerves  supplying  the  muscles  involved  in  the 
spasm.  The  operation  was  painstaking  and 
thorough  in  both  cases.  In  neither  case  was  any 
permanent  benefit  derived. 

Sedative  and  anti-spasmodic  drugs  are  like- 
wise of  little  value  in  these  cases,  so  that  both 
surgery  and  drugs  offer  but  slight  hope  of  relief 
to  the  unfortunate  sufferer  whose  plight  is  al- 
most inexpressible.  Massage,  systematic  and 
persistent,  resistive  motion  and  muscle  stretch- 
ing, on  the  other  hand,  are  of  genuine  and  last- 
ing value  in  the  condition  in  question.  Their  ef- 
fects are  not  immediate — indeed,  it  is  not  to  be 
expected  that  they  should  be;  but  the  ultimate 
relief  from  them  is  far  more  tangible  and  per- 
manent than  that  obtained  in  any  other  way. 
Another  distinct  advantage  possessed  by  the 
manipulative  method  in  these  cases  is  to  be 
found  on  the  psychic  side.  The  patient  feels 
that  something  definite  and  tangible  is  being 
done  for  him,  and  his  courage  to  make  the  fight 
for  recovery  is  sustained  thereby.  Those  of  you 
who  have  had  occasion  to  treat  cases  of  spas- 
modic wry-neck  will  at  once  recognize  the  im- 
portance of  this  aspect  of  the  treatment.  With- 
out the  encouragement  thus  derived,  the  pa- 
tient is  very  apt  to  develop  a  nielancholy  which 
leads  to  the  taking  of  dangerous  drugs  or  to 
actual  suicide. 

In  writer's  cramp  and  other  vocational  myo- 
spasms, the  curative  value  of  massage  and  gym- 
nastic exercise  is  overlooked  with  regrettable 
frequency  by  members  of  the  medical  profession. 
In  such  cases  we  are  dealing,  as  I  have  already 
said,  with  an  abuse  of  function  of  certain  finely 
coordinated  groups  of  muscles,  with  the  result 
that  when  the  endeavor  is  made  to  bring  the 
abused  muscles  into  function,  the  overwrought 
nerves  which  control  the  desired  coordinated 
muscular  activity  lose  their  controlling  power; 
and  the  end  result  is  spasm  of  the  muscles  called 
upon,  pain  and  other  evidence  of  disordered  sen- 
sibility. 

No  cure  is  to  be  expected  in  such  cases  so 
long  as  the  occupation  which  brings  about  the 


spasm  and  accompanying  discomfort  is  persisted 
in.  But  treatment  by  local  rest  and  tonics  sel- 
dom, in  itself,  suffices  to  bring  about  a  cure. 
What  is  needed  above  all  things  is  massage, 
usually  in  the  form  of  deep  manipulation.  This, 
however,  should  be  applied  to  the  muscles  which 
are  the  antagonists  of  those  in  spasm  rather  than 
to  the  spasmodic  group  itself.  The  rationale  of 
this  treatment  is  to  be  found  in  the  increase  in 
vigor  and  resisting  power  which,  by  the  treat- 
ment, is  imparted  to  the  resisting  muscles. 

The  next  class  of  cases  in  which  I  have  finally 
come  to  the  belief  that  massage  will  prove  its 
efficiency,  if  it  is  given  a  fair  trial,  is  that  of 
so-called  cerebral  contusion.    Cerebral  contusion 
of  the  modern  medical  nomenclature  is  identical 
with  what,  in  former  times,  was  commonly  called 
' '  concussion  of  the  brain. ' '    The  old  notion  was 
that  when  a  blow  of  moderate  severity  was  in- 
flicted upon  the  skull,  its  contents  were  shaken 
up  like  so  many  dried  peas  in  a  pod,  and  that 
the  symptoms  produced  were  due  to  a  temporary 
disarrangement  of  the  nervous  elements  of  which 
the  brain  is  composed.     Modern  pathologic  re- 
search has  shown  conclusively  that  this  notion  is 
entirely  erroneous.    As  a  matter  of  fact,  when  a 
wounding  force  of  moderate  severity  is  applied 
to  the  skull,  its  immediate  effects  are  primarily 
made  manifest  in  the  brain  bloodvessels.    These 
vessels  are  supplied    with   sympathetic    nerves 
which  afford  them  an  independent  power  of  con- 
traction and  dilatation.    Under  the  shock  of  an 
applied    force    the    sympathetic    or    vasomotor 
nerves  in  question  are  immediately  put  out  of 
function,  and  circulation  within  the  brain  ceases 
to  a  greater  or  lesser  extent.    With  this  cessa- 
tion in  vascular  function  two  things  immediately 
happen — first,  a  clotting  of  the  blood  in  certain 
capillaries;  and  second,  a  leakage  through  the 
vessel  walls  of  the  watery  contents  of  the  blood. 
If  only  a  small  area  of  the  brain  is  involved  in 
this    morbid    process,    the    circulation    finally 
rights  itself  and  the  watery  effusion  is  absorbed. 
If,  on  the  other  hand,  the  brain  area  involved 
is  extensive  and  the  amount  of  fluid  poured  out 
into  the  brain  substance  great,  the  burden  of 
absorption   and   removal   of   this   fluid   thrown 
upon  the  great  venous  pathways  from  the  brain 
is  so  overwhelming  that  these  conduits  fail  in 
their  function,  the  brain  becomes  waterlogged 
and  death  ensues. 

Up  to  the  present  time  the  measures  adopted 
by  the  surgeon  in  the  above-mentioned  situation 
have  been  inadequate  to  cope  with  the  effused 
death-dealing  fluid  with  entire  success,  and,  as  I 
have  already  said,  I  cannot  help  feeling  that  in 
massage  we  have  an  important  adjunct  to  the 
surgeon 's  endeavors.  A  stroking  or  effleurage  of 
the  neck  tends,  as  you  very  well  know,  to  a 
rapid  depletion  of  the  jugular  veins  and  creates 
a  sort  of  suction.  This  suction  would,  in  my 
opinion,  strongly  favor  the  evacuation  of  effused 
fluid  from  the  brain  itself  and  to  a  remarkable 
degree  the  drainage  established  by  the  trephin- 
ing operation  of  the  surgeon.     It  is  my  hope 


Vol.  CLXXII,  No.  13] 


BOSTON   MEDICAL   AND   SVROICAL   JOURNAL 


485 


that  in  the  future  the  masseur  may  have  increas- 
ing opportunities  to  prove  the  worth  of  his  ma- 
nipulations in  this  class  of  cases. 

Owing  to  the  fact  that  most  organic  diseases 
of  the  brain  and  spinal  cord  are  incurable,  the 
physicians  in  charge  of  cases  representing  these 
diseases  are  too  frequently  wont  to  limit  their 
tlierapeutic  endeavors  to  the  administration  of 
eitlier  iodide  of  potash  or  of  that  other  standby 
of  neurologic  therapy — strychnine.  More  often 
than  not,  under  these  circumstances,  the  iodide 
is  useless  and  the  strychnine  positively  harmful 
in  that,  by  its  stimulating  action,  it  serves  to  in- 
crease the  painfnl  mu.scular  contractures  accom- 
panying the  disea.se  under  treatment. 

In  the  majority  of  cases  where  the  lateral 
columns  of  the  spinal  cord  are  involved,  ma.ssage 
and  passive  motion  are  the  only  therapeutic 
agents  really  indicated.  It  matters  little 
whether  the  primary  focus  of  disease  is  in  the 
brain  or  in  the  cord  itself;  the  resultant  damage 
is  weakness  and  stiffness — sometimes  amounting 
to  actual  contracture — of  the  affected  limbs. 
And  to  these  disabilities  a  local  sluggishness  of 
circulation  is  not  infrequently  added  by  reason 
of  a  concomitant  disturbance  of  what  we  may 
term  the  check-rein  nerves  of  the  skin  blood 
vessels — the  vasomotors. 

The  value  of  massage  in  such  conditions  is 
twofold :  It  acts  centripetally,  stimulating  the 
tissues  about  the  central  focus  of  the  disease 
and  peripherally,  it  improves  circulation,  re- 
lards  muscular  wasting  with  ita  consequent 
weakness,  and  prevents  severe  deformities. 

There  are  many  who  scoff  at  any  measure 
designed  to  combat  the  ravages  of  organic 
disease  of  unknown  or  doubtful  origin  in 
the  central  nervous  system,  but  after  fairly  long 
experience  with  this  form  of  disea.se  I  can 
frankly  say  that  I  do  not  share  their  pessimism. 
I  have  just  spoken  of  the  value  of  massage  in 
lateral  column  disorders  and  will  now  speak  in 
turn  of  what  may  be  expected  from  it  in  affec- 
tions of  those  remaining  portions  of  the  cord 
which  are  of  the  greatest  and  best  known  func- 
tional importance, — the  anterior  gray  horns  and 
the  posterior  columns. 

In  that  disease  of  the  anterior  horns,  known 
as  progressive  muscular  atrophy,  I  cannot  truth- 
fully say  that  I  have  found  massage  of  any  par- 
ticular value,  but  in  what  we  may  term  the  late 
regressive  stages  of  infantile  paralysis — a  dis- 
ease of  this  same  region — there  is  no  qu&stion  of 
its  efficacy.  In  fact,  I  consider  it  of  as  great  im- 
portance in  the  maintenance  of  muscular  nutri- 
tion and  the  correction  of  paralytic  deformities 
as  any  other  measure  that  has  ever  been  adopted. 
To  obtain  the  best  results  from  it,  however,  its 
use  must  be  extended  over  a  long  period  of  time. 

Locomotor  ataxia  represents  the  most  com- 
monly encountered  disease  of  the  last-remaining 
portion  of  the  spinal  cord  above  mentioned,  and 
in  it  massage — either  alone  or  in  combination 
with  reeducation  in  coordinative  movements  of 
affected  muscles — serves  a  useful  purpose.    Here 


again  its  action  is  twofold,  as  in  the  case  of  lat- 
eral column  degeneration,  in  the  sense  that  its 
beneficial  effects  are  felt  both  peripherally  and 
centrally,  although  it  does  not  have  identical 
conditions  to  combat. 

In  Parkinson's  disease  {paralysis  agitans)  I 
have  found  mas.sage  very  useful  in  allaying  the 
feeling  of  tension,  stiffness  and  awkwardness 
that  so  often  accompanies  the  shaking.  Hero, 
however,  only  the  gentlest  kneading  and  the 
mildest  sort  of  passive  motion  should  be  applied. 

I  am  sorry  that  I  have  not  had  the  time  to 
specifically  indicate  the  other  forms  of  organic 
disease  of  the  central  nervous  system  in  which 
the  employment  of  the  therapeutic  agent  in  ques- 
tion is  attended  with  undoubted  benefit.  I  will 
say,  however,  that  it  should  be  more  frequently 
used  in  all  cases  of  central  disease  accompanied 
by  deformities  of  joints  and  in  the  majority  of 
those  associated  with  atrophy.  In  the  latter 
group  I  make  exception  of  syringomyelia  as  well 
as  of  the  so-called  progressive  muscular  atrophy, 
in  which  diseases  I  have  found  it  of  doubtful 
value  only. 

It  is  hardly  relevant  in  this  paper  to  speak  of 
the  use  of  ma.ssage  in  cases  of  peripheral  nerve 
suture  because  its  employment  in  such  cases  is 
the  rule  rather  than  the  exception.  But  I  can- 
not refrain  from  touching  upon  this  subject  in 
order  to  emphasize  one  very  practical  point, 
namely,  the  absolute  necessity  for  patient  per- 
severance. Even  where  early  end-to-end  suture 
of  a  divided  nerve-trunk  is  made,  the  process  of 
union  is,  as  a  rule,  tediously  slow  and  inexpres- 
sibly discouraging.  Months  may  clap.se  before 
massage  appears  to  make  any  satisfactory  im- 
pression upon  the  muscles  that  have  been  ren- 
dered wasted  and  inert  by  the  severance  of  their 
nutrient  nerve.  But  persistent  ma.ssage  acting 
centripetally  will  ultimately  bring  about  most 
gratifying  results  in  the  way  of  improved  nu- 
trition and  motion  in  the  affected  muscles.  In 
cases  where  surgical  union  of  a  divided  nerve  is 
delayed  for  some  time,  the  problem  of  the  mas- 
seur is  distinctly  greater  and  he  must  bring  into 
his  handling  of  the  case  a  fund  of  patience  that 
is  well-nigh  inexhaustible. 

With  the  above  digression  T  come  to  a  final 
group  of  morbid  nervous  phenomena  in  which 
the  use  of  massage  is  by  no  means  unknown,  but 
in  which  it  might,  with  great  profit,  be  more 
frequently  employed.  I  refer  to  phenomena 
which  represent  a  state  of  pathologic  exhaustion 
of  the  nervous  centres  and  which  are  classified 
under  our  present  rather  unsatisfaetoi^  nomen- 
clature as  symptom-complexes  of  the  so-called 
psychoneuroses. 

As  you  perfectly  well  know,  the  patient  with 
hysteria  or  neurasthenia  is,  with  annoying  fre- 
quency, looked  upon  by  physician  and  layman 
alike  as  the  victim  of  nothing  more  nor  less  than 
his  own  wilfully  morbid  imagination.  Such  a 
tenet  on  the  part  of  a  layman,  ignorant  as  he  is 
of  all  knowledge  of  anatomy,  physiology  and 
hygiene,  is  hardly  to  be  wondered  at.     When, 


486 


BOSTON  MEDICAL  AND    SUROWAL   JOURNAL 


[Apbii,  1,  1915 


on  the  other  liand,  a  physician  conducts  his 
treatment  of  the  pitiable  sufferer  from  exhausted 
nerve  centres  on  the  basis  of  the  same  tenet, 
the  raison  d'etre  of  this  treatment  is  akin  to  that 
of  the  exorcism  of  mediaeval  times. 

As  a  plain  matter  of  fact  the  problem  of  eti- 
ology in  exhausted  nervous  centres  is  far  too 
deep  and  subtle  to  be  disposed  of  in  any  offhand 
way.  Into  this  problem  I  shall  not  here  delve, 
but  shall  confine  myself  to  the  consideration  of 
those  clinical  manifestations  of  the  exhaustion 
in  which  the  use  of  massage  is  indicated  much 
more  often  than  it  is  actually  employed. 

Nervous  exhaustion  is  characterized  by  morbid 
emotional  states,  by  a  prompt  fatigability  of  mo- 
tor neurons,  by  perverted- sensibility  of  the  most 
varied  form  and  by  curious  morbid  fluctuations 
in  the  activities  of  that  delicate  mechanism 
known  as  the  great  sympathetic  nervous  system. 

In  the  severe  cases  the  feeling  of  fatigue  is  so 
marked  and  so  constant  that  it  is  with  the  great- 
est difficulty  that  the  sufferer  is  able  to  use  his 
upper  extremities  for  more  than  a  few  minutes 
at  a  time  or  to  drag  his  weary  legs  for  even  the 
shortest  distance.  The  advice  often  given  to 
such  a  person  by  the  misguided  medical  man  is 
to  take  more  exercise,  and  if  this  advice  is  fol- 
lowed, it  invariably  leads  to  such  an  increase  in 
the  exhaustion  that  existence  is  rendered  almost 
unendurable. 

What  such  a  person  really  needs  is  the  very 
gentle  stimulation  of  motor  neurones  and  volun- 
tary muscles,  which  skilfully  applied  massage  so 
marvelously  well  supplies.  Under  such  manipu- 
lation the  unhealthy  tension  of  over-tired  motor 
nerves  is  relieved,  the  muscles  lose  their  vice-like 
feeling  of  tension,  the  skin  circulation  is  equal- 
ized in  the  various  regions  of  body  and  extremi- 
ties and  the  emotional  tone  is  altered  for  the 
time  being  from  one  of  irritability,  anxiety  and 
depression  to  one  of  pleasant  languor. 

Under  the  same  sort  of  manipulation  the  ten- 
der and  at  times  extremely  painful  spine  is  re- 
stored to  normal  feeling.  I  have  been  particu- 
larly struck  by  the  analgesic  action  of  carefully 
graduated  massage  in  this  condition;  indeed,  I 
have  frequently  seen  spines  so  exquisitely  tender 
at  the  outset  that  the  lightest  effleurage  of  a 
gentle  operator  was  intolerable,  gradually  be- 
come, under  this  treatment,  so  free  from  morbid 
sensitiveness  that  even  the  heaviest  handling  was 
grateful  rather  than  otherwise. 

We  come,  finally,  to  a  consideration  of  the  dis- 
turbances which  arise  through  the  faulty  work- 
ing of  the  great  sympathetic  system  in  states  of 
nervous  exhaustion.  It  has  always  seemed  to 
me  curious  that  Nature  has  put  such  a  burden 
of  function  upon  this,  the  most  delicate  part  of 
the  dynamo  that  runs  the  human  machine.  But 
such  is  the  fact. 

At  times  it  governs,  at  other  times  it  is  gov- 
erned by,  our  emotional  life.  It  regulates  the 
amount  of  blood  that  at  any  one  time  is  in  a 
particular  part  of  the  brain.  It  controls  respi- 
I'ation,  the  beat  of  the  heart,  digestion,  glandular 


secretion  in  general,  the  secretion  and  excretion 
of  urine,  the  peristaltic  action  of  the  bowels,  the 
menstrual  function  and  the  surface  circiTlation — 
in  a  word,  it  holds  the  sceptre  over  a  very  large 
territory  in  the  human  economy.  Hence,  when 
it  is  brought  by  exhaustion  to  a  state  of  irritabil- 
ity it  produces  the  over-activity  in  brain  circula- 
tion which  underlies  insomnia,  the  cold,  mottled 
and  moist  extremities,  the  suffocated  feelings, 
the  palpitations,  the  sluggish  and  painful  diges- 
tion, the  constipation,  the  increased  or  dimin- 
ished urinary  output,  and  the  painful,  delayed 
and  scanty  menstruation  so  often  encountered  in 
the  victims  of  the  so-called  psychoneuroses. 

Here  is  a  pathologic  problem  with  which  no 
system  of  therapy  that  does  not  give  a  prominent 
place  to  massage  can  possibly  hope  to  cope  suc- 
cessfully. By  massage,  in  the  form  of  effleurage, 
we  can  deplete  the  over-filled  vessels  of  the 
brain  and  bring  about  the  much-needed  mental 
peace  and  refreshing  sleep.  By  the  same  agent 
we  can  equalize  surface  circulation  and  surface 
temperature. throughout  the  body  and  limbs;  we 
can  stimulate  sluggish  peristalsis  and  relieve  the 
pain  caused  by  the  distention  of  retained  flatus; 
we  can  prevent  the  sagging  of  the  stomach  and 
intestines  due  to  atony  and,  in  certain  cases,  we 
can— I  feel  confident— bring  about  a  return  to 
normal  of  the  menstrual  function. 

There  is  probably  nothing  in  this  very  brief 
communication  that  was  not  known  to  each  and 
every  one  of  you  long  since ;  but  it  was  not  my 
purpose  to  bring  to  your  notice  those  forms  of 
nervous  disorder  in  whose  treatment  massage  has 
not  as  yet  proved  its  practical  efficacy;  on  the 
contrary,  my  aim  was  to  stimulate  a  greater  ten- 
dency to  its  employment  in  cases  in  which  its 
therapeutic  value  is  practically  indisputable. 
This  T  have  not  done  as  thoroughly  as  I  should 
like,  but  as  thoroughly  as  my  limited  leisure  per- 
mitted. I  ask  your  indulgence  for  my  short- 
comings. 


jnpiitral  Pragrraa. 


KIGHTII     REPOI?T     OF     PROGRESS     IN 

ORTHOPAEDIC  SURGERY.* 

1?Y  Robert  B.  Osgood.  M.D.  ;  Robert  Soutter,  M.D.  : 

Hermann  Bucholz.  M.P.  :  ITarry  C.  IvOW,  M.D. ; 

AND  Murray  S.  Danforth,  M.D.,  Boston. 

(Concluded  from  page  432.) 

RICKETS.        OSTBOM.\LACI.\.         CHONDRODYSTBOPHIA 
FETALIS.       OSTEOGENESIS    IMPERFECTA. 

Weiss'"  reports  a  series  of  oases  of  rickets, 
some  mild  and  some  severe,  in  which  there  was  a 
very  marked  improvement  in  their  condition 
under  the  administration  of  tablets  of  the  ex- 
tract of  the  hypophysis.  This  improvement  oc- 
curred in  from  six  to  ten  weeks. 

Cavazzani"  had  observed  great  benefit  follow 


Vol.  CLXXII,  No.  13] 


BOSTON   MEDICAL  AND   SURGICAL  JOURNAL 


487 


the  administration  of  epinephrin  in  three  cases] 
of  osteomalacia.    The  disease  occurred  in  women  i 
who  had  borne  one  or  more  children.     In  the 
first  case  it  was  begun  about  a  week  after  thej 
first  symptoms,  which  had  come  on  acutely  a 
few  days  after  delivery.     The  treatment  was 
promptly  effectual.    In  the  second  case  the  osteo- 
malacia had  developed  not  long  after  delivery, 
but  two  months  had  elapsed  before  treatment 
was  instituted.    The  treatment  was  not  kept  up 
regularly  and  the  results  were  less  striking.    In 
the  third  case,  although  the  disease  had  existed 
for  a  long  time  and  there  were  irreparable  le- 
sions, a  very  marked  improvement  took  place. 

Wagner^^,  in  reporting  a  case  of  chondrodys- 
trophia  fetalis  transmitted  from  mother  to  child, 
calls  attention  to  the  influence  of  heredity  and 
the  fact  that  the  usual  transmission  is  from 
father  to  child.  -The  author,  while  admitting 
that  there  is  no  conclusive  evidence  of  specific 
disturbance  of  function  of  any  of  the  glands  of 
internal  secretion,  believes  that  there  is  probably 
a  hypersecretion  of  the  reproductive  glands 
which  causes  an  abnormal  development  of  mus- 
cles and  genitalia.  An  histological  study  reveals 
irregular  columns  of  cartilage  cells  at  the  epi- 
physeal line,  the  cells  being  pushed  apart,  espe- 
cially at  the  periphery,  as  if  the  periosteum  had 
been  driven  into  the  cartilage.  Wagner  thinks 
that  this  abnormality  of  enchondral  bone  forma- 
tion is  associated  with  increased  tension  in  the 
direction  of  the  long  axis  of  the  bone  by  the 
hypertrophied  muscles,  resulting  in  the  micro- 
melia. 

Bookman"    has    accepted  an   opportunity  to 
study  the  metabolism  in  a  case  of  osteogenesis  I 
imperfecta  for- a  considerable  period  of  time,  | 
especially  with  reference  to  the  calcium  reten-| 
tion  and  output.     His  three  conclusions  are  asi 
follows:   1.  Calcium  retention  may  be  much  be-; 
low  normal.    2.  During  the  course  of  the  disease 
it  varies  widely.   3.  Cod-liver  oil  and  phosphorus,  I 
and  more  especially  calicum  lactate  increa.se  the 
calcium  retention.     Bookman  compares  his  ob- 
servations with  the  earlier  work  of  Bamberg  and 
Huldchinsky",  who  after  a  study  of  their  own 
cases  and  a  review  of  the  literature,  conclude 
that  osteogenesis  imperfecta  (Vrolik)  and  osteo- 
psathyrosis idiopathica  (Lobstein)  present  very 
similar  clinical  pictures.    They  believe  that  fifty 
per  cent,  of  the  cases  of  osteopsathyrosis,  which 
condition  comes    on    at    varying   periods  after 
birth,  are  hereditary.    In  the  earlier  congenital 
osteogenesis  imperfecta  they  find  that  heredity 
plays  no  part.     A  histological  study  shows,  in 
contradistinction  to  the  picture  of  chondrodys- 
trophia    fetalis,  aplasia  of  the  compact  tissue 
and  spongy  substance  of  the  diaphysis  and  epi- 
physis with  normal  growth  of  cartilage,  result- 
ing in  the  development  of  slender  bones,  with 
little  spongy  substance  and  weak  compact  tissue. 
They  consider  that  disturbance  of  function  and 
defective  formation  of  the  periosteum  is  the  di- 
rect cause  of  these  changes.    Both  early  and  late 


forms  show  the  same  changes.  In  regard  to  the 
calcium  metabolism,  their  work  seems  to  show 
that  the  disease  is  not  caused  by  a  loss  of  cal- 
cium, but  by  the  incomplete  rudimentary  forma- 
tion of  the  bones  with  irregular  distribution  of 
calcium.  They  agree  with  Bookman  that  the  re- 
tention of  calcium  can  be  increased  by  phosphor- 
ized  cod  liver  oil.  The  prognosis  in  the  forms 
occurring  before  birth  is  bad.  Of  31  cases  col- 
lected, only  three  survived.  In  the  late  forms 
it  is  good,  in  105  cases  there  being  no  death  from 
the  disease. 

soouosis. 

In  a  series  of  22  cases  of  scoliosis,  not  selected, 
but  taking  all  in  which  good  x-rays  were  ob- 
tained, in  the  Orthopaedic  Clinic  of  the  Massa- 
chusetts General  Hospital,  Adams"  has  studied 
the  abnormalities  in  the  vertebral  column.  Two 
cases  showed  abnormalities  of  the  dorsal  verte- 
brae, and  nineteen,  abnormalities  of  the  low 
lumbar  or  sacral  segments.  The  only  remaining 
case  was  one  of  scoliosis,  following  poliomyelitis, 
in  which  there  was  no  bony  abnormality. 

[Ed.  Note. — Such  findings  in  x-rays  made  as 
a  routine  in  a  scoliosis  clinic,  show  the  need  of 
careful  study  of  the  lumbosacral  region  in  all 
cases  of  lateral  curvature,  for  upon  the  cause 
must  depend  to  some  extent  the  details 
of  treatment,  and  also  upon  the  cause 
must  depend  the  prognosis  as  to  our  ability  to 
maintain  a  correction  once  obtained.  If  we  can 
become  convinced  that  these  abnormalities  repre- 
sent the  cause  of  the  deformity,  we  are  at  once 
faced  by  the  question  as  to  whether  in  many 
cases  at  least  we  should  not  attempt  to  correct 
the  static  influence  of  the  deformity  by  opera- 
tion, either  before  or  after  the  correction  of  the 
scoliosis.  This  may  furnish  a  further  field  for 
bone  grafting  and  spinal  surgery  in  general. 
The  suggestiveness  of  this  paper  of  Adams  is 
enhanced  by  the  reports  which  come  in  from 
various  sources,  in  which  the  authors  from  their 
observations  feel  still  uncertain  as  to  the  perma- 
nence of  the  results  obtained  by  the  forcible 
methods  of  Abbott  and  others.] 

JOINT  SURGERY. 

Murphy"  has  written  a  valuable  paper  on  the 
technic  of  arthroplastic  operations  for  bony  and 
fibrous  ankylosis  of  the  temporomandibular  ar- 
ticulation. He  believes  the  cause  to  be  either  an 
infection  or  a  trauma  transmitted  from  the  chin. 
The  differential  diagnosis  as  to  which  side  of  the 
jaw  is  affected  may  be  extremely  difficult.  In 
the  intra-articular  ankyloses  there  is  sometimes 
a  little  motion  on  the  unaffected  side.  An  im- 
portant point  is  that  the  face  on  the  affected  side 
is  full  and  round  and  apparently  normal  in  ap- 
pearance, while  on  the  opposite  or  unaffected 
side  it  is  flattened  and  deformed.  The  chin  is 
always  more  or  less  retracted  and  deviates  to- 
ward the  ankylosed  side.  The  muscles  on  the 
affected  side  are  alwa.vs  more  atrophied.  The 
most   important  points   in  his  technic   are   an 


488 


BOSTON  MEDICAL  AND   SURGICAL  JOURNAL 


[Apeu,  1,  1915 


L-shaped  incision  in  front  of  the  ear  and  along 
the  zygoma.  No  attempt  is  made  to  remove  the 
head  of  the  bone  from  the  glenoid  cavity  on  ac- 
count of  the  danger  of  penetrating  the  skull. 
The  pedicle  flap  of  fat  and  fascia  is  lifted  from 
the  surface  of  the  temporal  muscle  and  turned 
downward.  A  wooden  wedge  is  inserted  be- 
tween the  jaws  on  the  affected  side.  Mastication 
is  begun  in  two  weeks.  He  reports  nine  cases 
with  good  results  in  eight. 

W.  L.  and  C.  P.  Brown"  describe  an  operation 
for  arthroplasty  of  the  shoulder  joint,  and  while 
they  have  had  only  one  case,  the  result  was  ex- 
cellent and  the  procedure  is  surely  ingenious. 
The  joint  is  exposed  by  an  anterior  incision. 
The  pectoralis  major  tendon  is  divided  at  the 
humerus  and  the  inner  fibres  of  the  deltoid  are 
also  divided.  The  short  head  of  the  biceps  is  cut 
across  about  4y2  inches  below  the  glenoid  and 
the  muscle  with  pedicle  attached  is  turned  into 
the  glenoid  and  fastened  by  sutures.  The  pec- 
toralis major  is  sutured  if  possible  and  the  arm 
put  up  in  abduction. 

Payr's^*  experience  in  arthroplastic  operations 
has  been  large  and  his- constant  attempts  to  im- 
prove his  technic  and  study  his  results  make 
the  report  of  his  further  experience  of  great 
value.    His  first  cases  are  now  about  four  years 
old.    He  is  still  impressed  with  the  importance 
of  the  removal  of  the  synovia  and  fibrous  carti- 
lage, and  if  possible  of  the  whole  capsule  as  well. 
His  experiments  seem  to  show  that  the  final  tis- 
sue covering  the  bone  ends  resembles  that  of 
tendon  sheaths.     He  has  never  seen  new  carti- 
lage formation,  and  the  bursa-like  nearthrosis  is 
a  unique  structure.     He  finds  that  the  ends  of 
the  bones  adapt  themselves  to  the  mechanism  of 
movement,  the  spongiosa  becoming  more  dense 
and  a  sort  of  cortical  bone  forming.    As  to  the 
indications,  Payr  considers  that  it  is  essential 
that  the  operation  should  be  deferred  until  long 
after  all  signs  of  active  inflammation  have  sub- 
sided.    He  believes  this  cannot  be  emphasized 
too  much.     Some  of  his  knees  have  been  done 
in  two  stages,  the  first,  the  mobilization  of  the 
patella,  and  later,  after  exercise  of  the  quadri- 
ceps, the  main  joint  has  been  reshaped.    He  ap- 
proaches the  joint  by  two  lateral  incisions,  hav- 
ing   abandoned    Kirschner's   method   of  trape- 
zoidal resection  of  the  tibial  tubercle,  because  it 
was  noticed  that  the  healing  of  the  bone  was 
not  good.     He  has  evidently  had  difficulty,  as 
have  the  Editors,  with  the  occurrence  of  bony 
spurs  on  the  posterior  edge  of  the  tibia  and 
femur.    He  believes  this  may  be  avoided  by  re- 
moving the  periosteum  from  this  region  as  ex- 
actly as  possible.     He  begins  massage  of    the 
muscles  early  and  gentle  movements  of  the  joint 
in  two  or  three  weeks.     He  employs  traction 
sufficient  to  separate  the  bones  as  much  as  he 
considers  necessary.     In  the  knee  he  considers 
90  to  100°  of  motion  all  that  is  desirable.     In 
bony  ankylosis  of  the  hip  he  considers  a  pseud- 
arthrosis  of  the  upper  end  of  the  femur  may  be 
the  best  procedure.    He  reports  11  cases  of  knee 


joints,  as  2  bad,  2  good,  7  very  good;  3  cases  of 
hip  joints  as  1  bad,  2  very  good ;  3  cases  of  el- 
bow joints,  as  1  good,  2  very  good ;  2  cases  of  fin- 
ger joints  as  successful ;  1  case  of  shoulder  joint 
as  unsuccessful. 


BONE   SUEGEKY. 

Lewis=^  summarizes  the  results  of  his  experi- 
mental work  in  bone  transplantation  as  follows : 
The  cortex,  without  periosteum,  endosteum,  or 
marrow,  will  remain  alive  and  proliferate  when 
small  bits  are  imbedded  in  muscle  tissue.  Direct 
contact  with  living  bone  is  unnecessary.  Large 
pieces  of  bone  transplanted  onto  live  bone,  re- 
main alive.  Bony  growth  may  fill  in  without 
the  aid  of  a  periosteal  or  bony  bridge,  and  strips 
of  fascia  may  take  the  place  of  the  periosteum 
as  a  limiting  and  nutritional  membrane.  In 
one  case  three  inches  of  the  excised  shaft  where 
the  periosteum  had  been  scraped  away,  was  re- 
generated in  this  way.  At  autopsy  nine  weeks 
later,  moderately  firm  bony  callus  was  present, 
and  the  fascia  had  fused  with  the  periosteum 
further  up  the  shaft  with  an  almost  indefinable 
dividing  line. 

Bond",  in  reporting  two  cases  of  successful 
transplantation  of  the  fibula  to  replace  the  tibia 
in  which  there  had  been  satisfactory  increase  in 
size  as  far  as  thickening  was  concerned,  but  not 
sufficient  growth  in  length,  discusses  the  con- 
trolling factors  in  this  growth.  There  seems  to 
be  little  reason  to  doubt  that  imperfect  epiphy- 
.seal  function  is  the  cause  of  defective  growth 
in  length.  He  believes  after  consideration  of 
various  theories  that  the  increase  in  thickness  is 
simply  in  response  to  the  necessity  of  function, 
and  that  we  may  expect  these  changes  in  trans- 
plants in  other  parts  of  the  body,  although  we 
are  unable  to  describe  the  process  of  cell  re- 
production which  brings  this  about. 

Mareozzi^i  recommends  a  mixture  of  equal 
parts  of  the  phosphate  and  carbonate  of  lime  as 
a  filling  in  bone  cavities.  It  is  easily  sterilized, 
readily  but  not  quickly  absorbed,  has  a  marked 
affinity  for  bone,  and  stimulates  osteogenesis. 
He  reports  good  results. 

FRACTURES    AND    DISLOCATIONS. 

Marsiglia^''  reports  experiments  undertaken 
on  dogs  to  determine  the  effects  of  injections  of 
emulsions  of  the  hypophysis  of  calves  after  frac- 
ture. It  was  found  in  the  dogs  studied  that  the 
consolidation  of  the  fractures  was  very  much  de- 
layed and  that  the  dogs  suffered  markedly  from 
toxemia,  loss  in  weight,  strength,  etc. 

Tanton*'  believes  that  the  gravity  of  fractures 
of  the  eoracoid  process  depends  less  on  the  break 
than  on  the  force  necessary  to  cause  the  lesion. 
Malgaigne  had  six  deaths  in  six  cases.  With 
dislocation  of  the  eoracoid  process  inward  there 
is  likely  to  be  contusion  of  the  bundles  of  the 
axillary  nerves,  causing  complete  paralysis  of 
the  upper  arm,  forearm,  and  hand.    This  occur- 


Vol.  CLXXII,  No.  13] 


BOSTON  MEDICAL  AND   BUBGIOAL  JOURNAL 


489 


rence  is  due  to  the  violence  rather  than  to  the 
fracture.       Secondary     nervous     complications 
often  arise  from  exuberant  overgrowth  at  the 
point  of  fracture.     In  five  out  of  six  cases  re- 
ported  by   Dr.    Guelt   only   fibrous   union   oc- 
curred.   With  displacement  of  a  coracoid  proc- 
ess there  may  be  a  functional  impotence  evi- 
denced by  a  lack  of  power  in  the  forward  mo- 
tions of  the  arm.     Treatment  should  consist  in 
immobilization  for  twelve  to  fourteen  days  in  i 
forced  adduction  with  a  flexed  forearm  and  thej 
elbow    elevated.     "Where    there    are  persistent] 
symptoms     from    exuberant     overgrowth     this! 
should  be  removed.  j 

Saar**  has  treated  six  cases  of  old  fractures 
of  the  lower  end  of  the  humerus  which  had  | 
healed  with  great  backward  displacement  and ! 
complete  or  nearly  complete  loss  of  function  of, 
the  elbow.     In  all  these  cases  he  mobilized  the 
lower  fragment  by  carefully  dissecting  away  all 
scar  tissue.    In  some  of  the  cases  the  lower  frag- 
ment lay  entirely  free.     He  then  corrected  the 
position  and  retained  the  bone  by  mortising  it 
to  the  shaft.    In  no  cases  did  necrosis  occur,  and 
the  results  in  all  his  cases  were  good,  in  two  of 
them  normal  motion  being  obtained. 

Anzilotti*",  from  a  careful  study  of  two  cases 
of  forward  dislocation  of  the  head  of  the  radius, 
one  recent  and  one  of  a  year's  duration,  con- 
cludes that  in  a  recent  case  one  should  attempt 
reduction  without  open  operation,  but  in  case  of 
failure  to  reduce  or  to  maintain  the  reduction 
one  should  make  an  incision  down  to  the  head 
and  replace  it,  after  removing  any  obstacle.  In 
old  dislocations  it  is  necessary  to  open  the  joint, 
remove  any  obstacles,  and  if  possible  replace  the 
head.  If  this  is  found  impossible  one  should  re- 
move just  enough  of  the  head  to  permit  reduc- 
tion. 

Walbaum*'  reports  two  cases  of  the  rare  frac- 
ture of  the  lesser  trochanter,  of  which,  accord- 
ing to  his  statement,  only  12  cases  have  hereto- 
fore been  published.  In  both  ca.ses  the  fracture 
occurred  in  connection  with  running  fast;  one 
patient  feeling  the  tear  as  he  abruptly  stopped. 
The  symptoms  are  pain  and  limping  in  walking, 
tenderness  over  the  lesser  trochanter,  free  pas- 
sive motion,  but  pain  in  active  motion  of  the 
hip  joint.  Ludloff's  sign,  the  inability  to  lift 
the  leg  from  lying  position,  was  positive  in  one 
case,  but  negative  in  the  other.  The  author  be- 
lieves, therefore,  that  in  the  latter  case  only  a 
part  of  the  lesser  trochanter  was  torn  off. 

Balthazard*' ,  adds  another  to  the  cases  on 
record  in  which  after  a  fall,  the  patient  com- 
plaining only  of  vague  pains  in  the  lumbar  re- 
gion, an  actual  fracture  of  the  spine  had  oc- 
curred. He  walked  home  after  the  fall,  but 
by  the  sixth  month  he  complained  of  girdle  pains 
and  there  was  a  hump  in  the  dorso  lumbar  re- 
gion. He  died  from  an  intercurrent  disease,  and 
necropsy  revealed  that  the  spine  had  been  frac- 
tured, the  body  of  one  of  the  vertebrae  had  been 
crushed,  and  the  transverse  lamellae  broken,  but 
the  spinous  processes  were  intact. 


[Ed.  Note. — We  believe  that  fractures  of  the 
spine  are  much  more  common  than  we  have 
been  accustomed  to  consider  them.  They  are 
associated  in  our  minds  with  severe  immediate 
symptoms,  usually  of  cord  pressure  and  kyphos, 
whereas  frequently  the  immediate  symptoms  are 
very  slight  and  no  kyphos  is  present.  The  se- 
rious nature  of  the  injury  is  revealed  later  when 
pressur^e  symptoms  begin.  We  feel  sure  that 
all  injuries  of  the  spine  should  have  an  x-ray 
examination  and  that  when  a  fracture  is  found, 
immobilization  should  be  advised  for  several 
months] 

Albee**  advocates  in  certain  fresh  fractures 
inlaying  a  bone  graft  and  fastening  it  with 
bone  autoplastic  pegs.  With  accurately  ad- 
justed twin  saws  a  piece  of  bone  is  cut  out  of  the 
long  fragment  about  five  inches  in  length  and  a 
small  piece,  21/2  inches  in  length  and  of  exactly 
the  same  width  and  exactly  opposite  the  trough 
in  the  long  fragment,  is  cut  from  the  short  frag- 
ment. From  this  smaller  piece,  bone  pegs  are 
fashioned  by  a  dowelling  machine.  The  longer 
piece  is  inserted  in  the  short  fragment  and  ex- 
tends an  equal  distance  into  the  long  fragment 
and  is  retained  by  the  bone  pegs  driven  tlirough 
drill  holes. 

Davidson"  reports  excellent  results  in  six 
cases  of  fracture  treated  by  the  introduction  of 
autoplastic  bone  pegs  made  from  the  tibia. 
These  were  introduced  into  the  medullary  canal 
in  all  cases  except  in  fracture  of  the  neck  of  the 
femur,  in  which  a  canal  was  made  through  the 
trocanter. 

[Ed.  Note. — It  is  quite  evident  to  the  Editors 
that  a  course  in  carpentry  will  soon  be  a  neces- 
sary part  of  the  education  of  every  well 
equipped  surgeon.] 

MISCELLANEOUS. 

Brandes*'  has  studied  the  time  of  appearance 
and  the  character  of  bone  atrophy  caused  by 
disease.  He  chose  the  os  calcis  of  rabbits  as 
most  suited  to  his  experiments  and  observed  the 
changes  in  it  as  a  result  of  resecting  a  portion 
of  the  tendo  Achilles.  An  atrophy  involving 
both  the  spongy  anl  compact  bone  occurred  in 
one  week.  The  tibia  and  the  anterior  bones  of 
the  foot  were  involved  also.  When  the  function 
was  only  partially  taken  away,  as  by  a  plaster 
cast,  an  atrophy  began  very  early  and  was  di- 
rectly proportional  to  the  completeness  of  the 
lack  of  use.  From  these  experiments  the  author 
concludes,  as  did  Legg  as  the  result  of  his  sim- 
ilar experiments,  that  the  atrophy  seen  in  dis- 
ease is  the  result  only  of  the  disuse,  and  not 
characteristic  of  any  special  disease, — for  ex- 
ample, tuberculosis. 

A  type  of  enteric  fever  due  to  the  bacillus 
Columbensis  was  first  described  by  Castellani" 
in  1905.  Certain  cultural  characteristics  and 
sugar  differentiate  this  organism  from  others  in 
the  paratyphoid  group.     He  describes  a  case 


490 


BOSTON   MEDICAL   ASD   SURGICAL  JOURNAL 


[Apbii-  1,  1915 


of  this  type  of  fever,  in  which  there  were  sinuses 
in  the  arm,  persisting  for  over  a  year,  from 
which  spicules  of  bone  were  discharged,  and 
from  which  cultures  of  the  B.  Columbensis  were 
isolated.  This  apparently  represented  a  perios- 
titis due  to  one  of  the  organisms  of  the  typhoid 
group.  The  infection  is  always  mild,  persistent, 
and  runs  a  subacute  course. 

Dehon  and  Hertz°^  give  the  details  in  fourteen 
eases  of  angiosclerotic  dystasia  or  intermittent 
claudication,  and  call  attention  to  the  fact  that 
syphilis  was  known  in  half  of  them.  This  large 
percentage  suggests  the  importance  of  at  least 
tentative  treatment  for  syphilis  in  all  cases  of 
obliterating  arteritis  of  the  legs.  One  of  their 
patients  improved  remarkably  under  specific 
treatment  and  the  Wassermann  reaction  became 
negative.  Some  with  known  syphilis  had  a  nega- 
tive reaction.  In  some  with  known  syphilis,  the 
intermittent  claudication  was  not  benefited  in 
the  least  by  the  specific  treatment.  Tobacco  and 
alcohol  seemed  to  be  contributing  factors  in  some 
of  the  patients,  possibly  outweighing  in  im- 
portance the  syphilis -in  these  eases.  They  urge 
that  if  any  signs  of  tabes  or  leukoplakia  are 
present  there  should  be  a  trial  of  specific  treat- 
ment in  every  case  of  intermittent  claudication, 
even  if  there  is  nothing  else  to  suggest  syphilis 
and  the  Wassermann  reaction  proves  negative  at 
the  first  test. 

Bailey"  reports  four  cases  of  spinal  cord  tu- 
mor and  calls  attention  to  the  fact  that  in  these 
tumors  pain  may  be  absent,  or  present  only 
slightly  and  at  intervals.  Also  that  the  presence 
or  absence  of  pain  is  not  of  value  in  determining 
whether  the  tumor  be  extra-  or  intra-meduUary. 
He  says,  "We  shall  have  to  take  the  same  posi- 
tion in  regard  to  spinal  cord  tumors  as  we  have 
taken  for  years  in  regard  to  tabes,  that  is,  that 
pains  may  be  absent  iii  a  disease  which  is  usually 
highly  painful,  and  that  the  absence  of  it  in  any 
case  presenting  other  suflScient  symptoms  does 
not  vitiate  the  diagnosis. ' ' 

Goldthwait"  has  written  a  suggestive  article 
intended  to  reach  the  lay  public  on  the  effects 
of  habits  of  posture  on  health. 

[Ed.  Note. — It  is  undoubtedly  true  that  faulty 
posture  maintained  in  industrial  life  becomes  a 
fixed  habit  and  that  careless  lack  of  attention 
also  allows  a  poor  posture  to  become  an  habitual 
position  of  a  physically  weak  individual.  These 
conditions  may  predispose  to  various  chronic 
diseases.  Although  it  is  quite  true  that  many 
persons  live  to  be  three  score  years  and  ten,  work 
hard,  and  "never  have  a  sick  day,"  and  yet  are 
round  shouldered,  with  sagging  abdomen,  and 
pronated  feet,  the  efiiciency  of  these  individuals 
must  be  lessened  by  these  factors.  Our  atten- 
tion needs  to  be  called  to  these  matters,  but  let 
us  not  stop  there.  Proper  posture  should  be  a 
study  in  every  school,  ranking  with  other  lessons, 
and  its  acquirement  made  essential  to  promo- 
tion. Gymnasia,  with  instructors  trained  in  the 
methods  of  inducing  proper  posture  must  be 


developed  for  general  use,  if  we  are  going  to 
reach  more  people  than  those  few  to  whom  we 
can  say,  "Sit  up  straight."] 

An  article  by  Lovett'''  on  "The  Causes  and 
Treatment  of  Chronic  Backache,  with  a  Consid- 
eration of  the  Diagnosis  of  Sacro-iliac  Eelaxa- 
tion ' '  should  be  generally  read,  as  the  expression 
of  opinion  of  an  eminent  orthopaedic  surgeon 
who  has  given  much  thought  to  the  subject. 
Leaving  out  of  consideration  the  backaches  due 
to  tuberculosis,  organic  nervous  disease,  and 
spinal  fractures,  he  considers  the  common  causes 
are :  1.  Pelvic  conditions.  2.  Traumatisms.  3. 
Arthritis.  4.  Defective  balance.  Sacro-iliac 
strain  or  relaxation  as  an  entity,  he  considers 
very  rare,  believing  that  the  backache  when  lo- 
cated in  this  region  may  be  attributed  to  strain 
upon  the  muscles,  attachments  and  ligaments  in 
this  region,  causing  a  condition  of  hypersensi- 
tiveness  and  tenderness  in  which  the  sacroiliac 
ligaments  are  in  some  cases  involved.  He  be- 
lieves that  the  measures  often  employed  to  sup- 
port the  sacroiliac  joints,  such  as  adhesive  plas- 
ter and  belts,  are  entirely  insufficient  to  really 
hold  the  articulation,  and  are  successful  only 
when  they  give  support  to  strained  muscles  or 
help  to  maintain  a  proper  balance.  The  most 
useful  methods  of  treatment  he  considers  to  be : 
1.  Measures  to  obtain  proper  balance,  such  as 
corsets,  etc.  2.  Proper  shoes  and  sometimes  sup- 
ports for  the  back.  3.  Later  exercises  to  develop 
the  musculature. 

[Ed.  Note. — It  is  not  clear  from  the  article 
what  the  author  considers  the  cause  of  the  com- 
mon sciatic  and  other  nerve  root  pain  which  so 
commonly  accompanies  both  the  attitudinal,  the 
traumatic,  and  the  arthritic  low  backaches. 
These  are  frequently  relieved  by  protecting  the 
sacroiliac  joints  and  these  alone,  by  such  a  pro- 
cedure as  the  Italian  laborer  has  learned  to 
adopt,  when  if  hard  digging  is  to  be  done  he 
shifts  his  belt  from  his  waist  to  below  the  level 
of  his  anterior  superior  spines.  He  does  not 
know  that  the  difference  of  a  few  inches  in  the 
circular  construction  makes  the  difference  as  to 
whether  the  sacro-iliac  joints  are  sprung  apart 
by  pressure  applied  at  the  level  of  the  crests  of 
the  ilia  or  held  together  by  pressure  exerted  in 
the  sulcus  between  the  trochanter  and  the  ante- 
rior superior  spines,  but  such  is  the  fact  and  he 
does  know  that  his  back  does  not  ache  when  he  is 
thus  protected.  The  author  is  quite  right  in 
saying  that  any  actual  displacement  of  the 
sacrum  downwards  is  unlikely  and  possible  only 
as  a  result  of  very  great  trauma.  None  of  the 
anatomists  or  clinicians  who  have  carefully  stud- 
ied the  movements  of  the  sacrum  have  main- 
tained that  this  occurred.  (Goldthwait:  Boston 
Medical  and  Surgical  Journal,  May  25  and 
June  1,  1905.  Bouvarre  et  Biie:  La  Presse 
Medicate,  Aug.  9,  1899.  Herman  Myer :  Archiv. 
filr  Anatomie,  1878,  p.  1.  L.  Dieulafe :  Bibliog- 
raphie  Anatomique  Supplement,  1904,  p.  109.) 
Nevertheless,  the  rotation  of  the  sacrum  on  its 
horizontal  axis  through  the  second  sacral  ver- 


Vol.  CLXXII,  Xo.  13] 


BOSTON   MEDICAL  AND   SURGICAL  JOURNAL 


491 


tebra  and  slight  displacements  or  subluxations 
beyond  of  this  normal  arc  of  motion,  which  the 
author  does  not  mention,  are  quite  common,  we 
believe,  and  demonstrable  both  to  palpation  and 
also  in  good  stereoscopic  x-ray  plates.  We  can- 
not explain  relief  of  nerve  root  pain,  when  the 
sacroiliac  joints  are  protected  by  the  theory  of 
relief  of  strain  on  the  ligaments  and  muscle  at- 
tachment of  the  low  back,  nor  can  we  explain 
thus  the  quick  relief  which  is  often  dramatic, 
which  sometimes  follows  manipulation  of  the 
joints,  either  with  or  without  an  anesthetic. 
Muscle  attachment  and  ligamentous  strain  from 
faulty  attitude  and  balance  are  surely  a  very 
common  cause  of  backache,  but  there  will,  in  our 
opinion,  be  left  many  cases  not  explainable  on 
this  theory  alone,  and  in  these  we  believe  that 
lesions  of  the  sacroiliac  joints  and  strains  in 
which  abnormalities  of  the  articular  and  trans- 
verse processes  of  the  fifth  lumbar  are  present, 
will  be  found  not  infrequently.] 

RirZUHCU. 

>DiiCosU:     Annila    of   Surgery,    June,    1914. 

•Wilson  «nd  Roaenberger:     N.  Y.  Med.  Jour.,  June  14,  IMJ. 

*  Froelich :  Arch,  de  Med.  dea  Enfints,  March,  1914. 

*  Huntincrton:     Annals   o(  Surgery,  June.    1914. 
•Vulpius:    Berliner   klin.   Woch.,   Apr.    18,   1914,  p.   M«. 

*  Jacobs:    Illinois   Med.    Jour.,  Aug.,   1914. 

'  Becchcrle:     Policlinico,  March  IS,  1914,  p.  127. 

■Roeenow:     Jour.     A.    M.    A.,    April    11.    1914,    p.    1146. 

•Axhausen:  Zfschr.  f.  orth.  Chir.,  191S,  xxxlil  Bd.,  1-2  H.. 
p.  223. 

■•  von  Manteuffel :    Deutsche  Ztachr.   f.   Chlr.,  1918,  cxxir,  821. 

"Hastings:   Jour,    of    Exp.    Med.,   Julv    1,    1914,    p.    52. 

"Thalhimcr   and    Rothschild:     Jour.    Exp.    Med.,   May,   1914. 

"Moore:    Jour,  of  Inf.  Diseuea,  Jul.v,  1914,  p.  218. 

"«reeley:    Med.  Record.  June  18,  1914.   p.   1078. 

"Brackett:    Boston  Mfd.  aud  Subo.  Jou».,  July  9,  1914,  p.  68. 

>*Mannir«  and  Fassett:  Arrblvea  of  Pediatric*.  June,  1914, 
p.    415. 

"O'Mallay:  Annals  of  Otology,  Rhinology,  and  Laryngology, 
Dec..   1918,  p.   1007. 

"Rolant:  Diss.  Petrograd,  1918;  Abstr.,  Surg.,  Gya,  and  Obstet, 
March,   1914,   263. 

'•Perthes:     Deutsche  Ztacbr.   f.   Chlr.,  1910,   Bd.   107,   p.   111. 

*>Drehmann:    Beitr.   z.    kiln.   Chir.,   xcl,   p.    642,   1914. 

"O'Reilly:    Am.   Jour.   Orth.  Sure..   Jan.,   1914. 

>•  Jones:   Clinical   Jour.,   London,  May   18,   1914. 

"Saunders,  Meisenbach,  and  Wisdom:  Miaiourl  State  Med. 
Assoc.,  March,   1914. 

>*  Francis:   Jour,  of  Infectious  Disease*,  July,  1914. 

"Flexner,  Clark,  and  Amon:  Jour.  Exp.  Med.,  Feb.  2,  1914, 
p.   194. 

"Robert  Jones:    Ijncet,  May  80.  1914,   p.   1615. 

"Netter:    Bull,  de  lAcad.  de  Med.,  April  7,  1914. 

"Fraser:    Am.  Jour,  of  Med.  Sciences,  July,  1914,  pp.  1-22. 

"Peltesohn:     Berliner  klin.   Wnrh.,  June  22,   1914,  p.    1162. 

••Weiss:    Therap.  Monatsschr.,  Berlin,   1918,  xxrll,  p.   400. 

•lOaTazzani:     Policlinico,    April    19,    1914,    Txll,    No.    16. 

•"Wagner:     Arch.   f.    Gynlk.,   191S.  C,   No.    1. 

«*  Bookman:     Am.   Jour.    Dls.  Children.   June,  1914,   p.   486. 

"Bamberg  and  Huldschinsky :  Jahr.  f.  Kinderheilk.,  1913,  Ixniil, 
p.   214. 

••Adams:    Boston  Med.  *jid  Simo.  Jorn.,  Mar  21,  1914.  p.  786. 

••Murphy,   J.  B. :    Jour.   A.   M.   A.,  June  6.  1914,  p.   1788. 

"Brown,  W.  r,.,  and  C.  P.:  Jour.  A.  M.  A.,  May  2,  1914, 
p.    1889. 

••Payr:  Deutsche  Ztscbr.  f.  Chlr.,  cxxix,  F.  Trendelenberg 
Festschrift. 

••I^ewls:    Surg.,  Ovn.,  and  Obstet..  May,  1914. 

"Bond:  British  Jour,  of  Surg..   April,   1914,  p.   610. 

»>Marc07j:i:     1.8    Riforma   Medica.   May  16,   1914,  p.    680. 

"Marsiglia:     La   Riforma    Medica.    Mar   9.    1914,   p.   505. 

"Tanton:     Gazette  des  Hop.,  Ixxxvi.  No.   107,  p.   1667. 

"Saar:    Deutsche  Ztschr.   f.   Chir.,  cxxvlil,  p.  29,  1914. 

"Anzilotti:    La   Riforma   Medica,   March   14,    1914,   p.    289. 

••Walbaum:    Deutsche  Ztschr.   f.  Chlr.,   cxxvlil,  p.   189,   1914. 

«' Balthazard:     Re^■.    de   Chir..    xxxlv,    Mav,    1914,   No.    8. 

"Albce:    N.   Y.  Med.  Jour.,  May  28,  1914. 

"Davidson:    Jour.   A.   M.  A.,  May  16.  1914,  p.  1851. 

"Brandes:  Fortschr.  a.  d.  Geb.  d.  Roentgenstrahlen,  1914,  xxi, 
p.   551. 

"Castellanl:  Jour,  of  Tropical  Med.  and  Hygiene,  June  16, 
1914,  p.    177. 

••  Dehon  and  Herti :  Ar«hlre»  des  Maladies  du  Coeur,  etc.,  June, 
1914,  vii,  p.   6. 

••Bailey:    Jour.  A.  M.  A.,  July  4,  1914,  p.  «. 

•«  Goldthwalt :    Journal  of  Outdoor  Life,  April,  1914. 

"Lovett:    Jour.  A.  M.  A.,  May  28,  1914,  p.   1615. 


Sook  ilrtmma. 


A  Text-Book  of  the  Diseases  of  the  Nose  and 
and  Throat.  By  Jonathan  Wriqht,  M.D., 
Director  of  the  Department  of  the  Laborato- 
ries of  the  New  York  Post-Graduate  Medical 
School  and  Hospital;  and  Harmon  Smith, 
M.D.,  Surgeon  of  the  Throat  Department  of 
the  Manhattan  Eye,  Ear,  Nose  and  Throat 
Hospital;  Clinical  Professor  of  Laryngology 
and  Rhinology,  Cornell  University  Medical 
School.  Illustrated  with  313  engravings  and 
14  plates.  Philadelphia  and  New  York:  Lea 
and  Febiger.    1914. 

This  is  a  new  text-book  of  650  pages.  It  is 
stated  in  the  preface  that  "the  exceptional  fea- 
ture in  the  book  is  the  emphasis  laid  upon  the 
etiology  and  pathology  of  disease"  and  that 
"much  of  this  work  rests  on  original  investiga- 
tion in  the  laboratory  and  clinic."  One  of  the 
authors  is  an  investigator  and  a  philosopher, 
whose  opinion  in  pathological  problems  has  long 
been  sought,  and  who  in  addition  to  his  other 
writing  has  given  us  a  classical  history  of  laryn- 
gology. The  other  is  a  well-known  clinician  and 
operator.  They  have  worked  together  so  that 
tliere  are  no  abrupt  lines  of  demarcation  between 
the  academic  and  the  practical  portions  of  the 
text.  The  first  chapter  gives  briefly  the  various 
methods  of  examination.  The  next  on  the  exter- 
nal nose  includes  the  results  of  the  long  experi- 
ence of  one  of  the  authors  with  the  injection  of 
paraflSn.  The  description  of  the  minute  anat- 
omy, both  normal  and  pathological,  of  the  inter- 
nal nose  and  also  of  the  pharynx  and  larynx,  is 
one  of  the  striking  features  of  the  book.  An- 
other, which  will  undoubtedly  lead  to  its  wide 
u.se  for  reference,  is  the  description  of  the  va- 
rious neoplasms,  not  too  technical,  but  given  by 
the  hand  of  a  master.  The  selection  and  de- 
scription of  operations  on  the  accessory  sinuses 
and  nasal  septum  is  good  and  clear.  In  the  chap- 
ter on  neuroses  of  the  nose  is  included  hay  fever, 
which  is  apparently  looked  upon  as  largely  due 
to  a  yielding  on  the  part  of  over-sensitive  persons 
to  insignificant  irritations.  It  is  disappointing 
that  the  large  amount  of  study  which  has  re- 
cently been  given  to  the  theory  of  anaphylactic 
reaction  from  the  different  proteids  should  not 
be  taken  seriously.  The  important  subject  of 
the  borderline  between  normal  and  pathological 
adenoids  and  tonsils  is  judicially  discussed  and 
various  methods  of  operating  described.  A  val- 
uable chapter,  often  omitted  from  text-boooks,  is 
one  on  buccal  lesions,  with  which  the  specialist  is 
often  called  upon  to  deal.  As  a  whole  the  book 
is  a  worthy  addition  to  our  list  of  text-books  on 
the  subject,  and  justifies  its  promise  to  embody 
origrinal  points  in  etiology  and  pathology. 


492 


BOSTON   MEDICAL  AND   SURGICAL   JOURNAL 


[Apbu,  1,  1915 


THE  BOSTON 

An  independently  owned  Journal  of  Medicine  and  Surgery,  pub- 
Iish.:d  weekly,  under  the  direction  of  the  Editors  and  an  Advisory 
Committee,  by  the  Boston  Medical  and  Surgical  Joubnal  So- 
ciety, Inc. 

THURSDAY,  APRIL  1,  1915. 


Editors. 

Robert  M.  Green,  M.D.,  Editor-in-Chief. 

GEORflB  G.  Smith,  M.D.,  Assistant  Editor. 
Walter  L.  Burrage,  M.D.  1   „       ,,     „         i      .<     .,  j-    i  »     ■  . 
Frederick  T.  Lord,  M.D.     /  ''<"'  ">«  Uaesachmetts  Medical  Sonety. 

Committee  of  Consulting  Editors. 
Walter  B.  Cannon,  M.D.  Allan  J.  McLAnoHLiN,  M.D. 

Harvey  Cdshino,  M.D.  Robert  B.  Osoood,  M.D. 

David  L.  Edsall,  ILD.  Milton  J.  Rosenad,  M.D. 

Beid  Hunt,  M.D.  Edward  C.  Streeter,  M.D. 

Roger  I.  Lee,  M.D.  '  E.  W.  Taylor,  M.D. 

Advisory  Couuitteb. 

Edward  C.  Streeter,   M.D.,  Boston^  Chairman. 
Walter  P.  Bowers,  M.D.,  Clinton. 
Homer  Gage,  M.D.,  Worcester. 
Joel  E.  Goldthwait,  M.D.,  Boston. 
Lyman  A.  Jones,  M.D.,  North  Adams. 
Hugh  Williams,  M.D.,  Boston. 
ALFRED  Worcester,  M.D.,  Waltham. 
Robert  B.   Osgood,  M.D.,  Boston,  Secretary. 

Ernest  Gregory,  Manager.        W.  M.  Leonard,  Consulting  Manager. 
Subscription  Terms:     $^.00  per  year,  in  advance^  postage  paid, 
tor  the  United  States.     $6.56  per  year  for  all  foreign  countries  be- 
longing to  the  Postal  Union. 

The  zditor  will  be  in  the  editorial  office  daily,  except  Wednesday 
and  Sunday,  from  twelve  to  one-thirty  p.  m. 

Papers  for  publication  and  all  other  communications  for  the  Edi- 
torial Department  should  be  addressed  to  the  Editor,  126  Massachu- 
setts Ave.,  Boston.  Notices  and  other  material  for  the  editorial  pages 
must  be  received  not  later  than  noon  on  the  Saturday  preceding 
the  date  of  publication.  Orders  for  reprints  must  be  returned  in 
writing  to  the  printer  with  the  galley  proof  of  papers.  The  Journal 
will  .urnisk  the  first  one  hundred  reprints  for  half  the  cost  price. 

All  letters  containing  business  communications,  or  referring  to 
the  publication,  suiscription,  or  advertising  department  of  the  Jour- 
nal, shoula  be  addressed  to 

Ernest  Gregory,  Manager. 

126  Massachusetts  Ave.,  Comer  Boylston  St.,  Boston,  Massachusetts. 


NEW  AND  NON-OFFICIAL  REMEDIES, 
1915. 

The  1915  edition  of  New  and  Non-official 
Remedies,  published  by  the  American  Medical 
Association,  has  recently  been  issued.  This  little 
work,*  which  is  prepared  by  the  Council  on 
Chemistry  and  Pharmacy  of  the  Medical  Asso- 
ciation, is  not  as  well  known  to,  or  as  frequently 
consulted  by,  the  profession  as  it  should  be. 

As  the  name  implies,  the  book  deals  with 
drugs  which  have  recently  come  into  use  and 
with  those  which  are  not  yet  contained  in  the 
United  States  Pharmacopoeia.  Its  main  pur- 
pose is  to  give  physicians  a  truthful  account  of 
the  chemistry,  properties,  actions  and,  so  far  as 
these  have  been  determined,  the  therapeutic  use 
of  the  drugs  discussed.  As  a  source  of  informa- 
tion on  such  subjects,  it  should  largely  replace 
the    trade    circulars    of    manufacturers,    from 

*  Copies  of  "New  and  NonofBcial  Remedies"  may  be  obtained 
at  cost  price,  postpaid  (60  cents  tor  paper-bound,  $1.00  cloth- 
bound),  from  the  American  Medical  Association,  685  North  Dear- 
born street,  Chicago,  and  also  through  dealers  in  medical  books. 


which  SO  many  of  the  less  critical  members  of 
the  profession  derive  their  knowledge  of  the 
more  recently  introduced  remedies. 

As  examples  of  the  drugs  discussed  in  this  edi- 
tion, may  be  mentioned  salvarsan,  emetine,  theo- 
bromine and  theophyllin  (and  the  various  pro- 
prietary preparations  of  these,  such  as  diuretin 
and  theocin),  novocaine,  preparations  of  the  pi- 
tuitary gland,  various  vaccines  and  sera,  etc. 
The  list  is  not  limited  to  substances  used  for 
therapeutic  purposes;  it  discusses  also  the  most 
important  chemicals  and  re-agents  recently  intro- 
duced for  use  in  diagnosis,  such  as  phenolsulpho- 
nephthaleia,  the  Nogucni,  Abderhalden  and  von 
Pirquet  tests. 

A  very  useful  feature  of  the  work  is  the  fact 
that  the  names  of  the  manufacturers  who  make 
such  preparations  and  who  have  satisfied  the 
Council  that  their  products  are  as  represented, 
are  given.  It  may  not  be  generally  known  that 
the  American  Medical  Association  maintains  in 
Chicago  an  exceptionally  well  equipped  chem- 
ical laboratory  for  the  purpose  of  examining 
new  drugs;  this  laboratory  is  probably  the  best 
source  of  trustworthy  information  in  the  world 
on  such  subjects.  The  fact  that  so  many  physi- 
cians still  derive  so  much  of  their  information  on 
these  subjects  from  commercial  circulars  or  re- 
tail men,  in  preference  to  New  and  Non-official 
Remedies,  is  highlj-  discreditable  to  the  profes- 
sion. An  examination  of  the  reports  of  the 
chemical  laboratory  of  the  American  Medical 
Association,  or  those  of  the  United  States  Public 
Health  Service,  of  the  records  of  convictions  un- 
der the  National  Pure  Drug  and  Insecticide 
laws  will  show  how  little  reliance  can  be  placed 
upon  the  claims  of  many  manufacturers.  And 
yet  most  physicians  constantly  prescribe  and 
hospitals  constantly  buy,  at  exorbitant  prices, 
simple  Pharmacopoeia  drugs  under  proprietary 
names,  simply  because  the  manufacturers  say,  or 
insinuate,  that  their  products  are  superior  to  the 
U.  S.  P.  preparations,  although  the  quality  of 
the  latter  is  under  the  jurisdiction  of  the  United 
States  as  well  as  of  the  state  governments.  Why 
do  physicians  who  accept  such  statements  hesi- 
tate to  accept  other  statements  of  these  same 
manufacturers — those  concerning  the  value  of 
their  various  pastes  for  the  checking  of  cancer, 
of  various  toxins  for  pneumonia,  etc.,  as  well 
as  the  out  and  out  "patent"  medicines  (hair 
growers,  "manhood  restorers,"  etc.)  which  the 
same  firms  prepare  for  the  use  of  the  laity  ?    It 


Voi,.  CLXXII,  Xo.  13] 


BOBTON  MEDICAL  AND   SURGICAL  JOVRNAL 


493 


may  well  be  that  the  future  historian  of  medi- 
cine will  find  this  an  essentially  darker  period 
in  some  important  respects  than  that  of  a  cen- 
tury ago,  when  James  Jackson  and  John  C. 
Warren  knew  enough  about  the  drugs  they  used 
to  write  a  pharmacopoeia  for  the  Massachusetts 
Medical  Society. 

All  drugs  are  admitted  to  New  and  Non- 
official  Remedies  provided  they  meet  certain 
simple  requirements — requirements  based  upon 
principles  universally  accepted,  but  unfor- 
tunately not  adhered  to  by  the  medical 
profession;  they  must  be  non-secret,  ex- 
act information  as  to  composition  must  be 
given,  grossly  exaggerated  claims  as  to  use- 
fulness or  safety  must  not  be  made.  Powerful 
drugs,  the  use  of  which  by  the  laity  might  lead 
to  harm,  either  direct  or  indirect,  must  not,  ac- 
cording to  the  rules  governing  admission  to  the 
book,  be  advertised  in  a  way  to  invite  self-medi- 
oation.  With  these  simple  restrictions,  the  rea- 
sonableness of  which  is  self-evident,  all  new 
drugs  of  promise  are  eligible  for  admission. 
Physicians  should  regard  with  suspicion  all  pro- 
prietary preparations  which  are  not  included. 

The  reason  why  the  products  of  some  manu- 
facturers are  not  in  New  and  Non-official  Reme- 
dies is  that  these  firms  are  not  dealing  fairly 
with  the  profession  or  the  public. 

Another  feature  of  the  work  is  that  emphasis 
is  laid  upon  the  true  chemical  names  of  the 
drugs.  Many  physicians  will  find  that  they  are 
using  proprietary  names  and  so  helping  create 
monopolies  in  certain  official  drugs,  as  well  as 
in  certain  chemical  compounds;  the  use  of  va^ 
rious  proprietary  names  for  the  same  official 
drug  (as  in  the  case  of  hexamethylenamine,  for 
example)  often  leads  to  the  greatest  confusion. 


HEALTH  ASPECTS  OP  SCHOOL 
LUNCHES. 

The  medical  profession  is  to  be  credited  with 
initiating  the  movement  to  feed  children  at 
school.  Its  beginning,  in  England,  can  be  traced 
to  a  memorandum  issued  many  years  ago,  by  the 
director-general  of  the  Army  Medical  Service 
which  followed  the  wholesale  rejection  of  re- 
cruits because  of  physical  disability.  An  inves- 
tigation showed  that  the  conditions  responsible 


for  this  physical  decadence  were  directly  attrib- 
utable to  poverty,  that  this  in  turn  was  due  to 
the  change  brought  about  by  the  rapid  rise  of 
industrialism  following  the  adaption  of  labor- 
saving  machinery,  and  that  in  consequence  of 
the  prevailing  poverty  the  children  were  being 
reared  as  weaklings,  incapable  of  resisting  dis- 
ease and  largely  impervious  to  education.  As  a 
measure  of  relief  for  this  deplorable  situation 
the  inquisitorial  council  recommended  a  school 
lunch  service  for  needy  children,  to  be  main- 
tained at  the  public  expense.  An  examination  of 
over  330.000  children  (one-third  of  the  school 
population  of  the  city)  by  the  medical  inspect- 
ors of  the  New  York  Health  Department  in  1913 
disclosed  some  14,000  eases  of  malnutrition; 
and,  on  the  assumption  that  the  same  ratio  of 
this  condition  is  to  be  found  in  the  rest,  there 
would  be  more  than  40,000  children  in  the 
.schools  whose  health  is  impaired  owing  to  a  mal- 
nourished system.  It  has  been  ascertained  that 
in  Cincinnati,  of  36,438  children  examined. 
1619  were  suffering  from  malnutrition;  in  Cleve- 
land, of  61,578,  671 ;  in  Newark,  N.  J.,  of  27,971, 
940;  in  Rochester,  N.  Y.,  of  18,497,  945;  and  in 
Worcester,  Mass.,  of  18,342,  389. 

While,  of  course,  the  provision  of  a  suitable 
meal  at  noon  is  inadequate  to  overcome  such  mal- 
nutrition, the  school  lunch  service  is  undoubt- 
edly a  palliative  measure  of  great  practical  serv- 
ice, and  one  which  can  be  made  productive  of  a 
widespread  influence  for  good.  In  the  latest 
Monthly  Bulletin  of  the  New  York  City  Depart- 
ment of  Health  there  is  published  a  valuable 
contribution  on  this  subject  by  Edward  F. 
Brown,  executive  secretary  of  the  school  lunch 
committee  of  the  Association  for  Improving  the 
Condition  of  the  Poor.  From  this  it  is  learned 
that  the  New  York  School  Lunch  Committee  was 
organized  in  1907  for  the  following  purposes: 
1.  The  provision  of  nourishing  lunches  on  a  self- 
supporting  basis  for  public  school  children.  2. 
Special  observation  of  children  whose  physical 
condition  is  such  as  to  give  evidence  of  lack  of 
proper  nourishment,  in  order  to  determine  the 
underlying  causes  by  a  study  of  their  homes  and 
environment.  An  extension  of  this  aim  requires 
tliat  these  selected  cases  be  followed  up,  to  the 
end  that  the  proper  agency  may  be  apprised  and 
appropriate  action  taken.  3.  The  formation  of 
special  classes  of  mothers  for  instruction  in  the 
proper  care  of  children,  and  particularly  those 
suffering  from  poor  nourishment.     It  will  thus 


494 


BOSTON   MEDICAL  AND   SURGICAL   JOURNAL 


[April  1,  1915 


be  seen  that  the  work  of  this  committee  is  very 
much  more  comprehensive  than  the  mere  pro- 
viding of  nourishing  noonday  lunches.  The  need 
for  a  school  lunch  system,  as  Mr.  Brovm  says, 
ought  really  to  be  regarded  as  a  symptom  of  a 
serious  social  disorder.    The  necessity  of  feeding 
children  at  school  usually  arises  from  eithef  a 
demoralized  home,  where  the  housewife  has  to 
work  out,  indifference  of  the  housewife,  or  igno- 
rance of  home  economics.    The  service  of  a  noon 
meal  is  at  best  to  be  considered  inadequate  for 
a  number  of  reasons,  among  which  may  be  men- 
tioned the  following:  Behind  each  child  in  need 
of  such  a  service  is  a  home  lacking  the  facilities 
for  proper  feeding;  for  such  a  child  the  need  is 
just  as  great  for  its  other  meals  and  for  feeding 
on  non-school  days  and  in  the  summer  recess; 
the  presence  in  the  family  of  children  of  pre- 
school age ;  the  fact  that  any  desirable  effect  re- 
sulting from  the  scientific  feeding  of  the  child 
at  one  meal  time  at  school  is  likely  to  be  de- 
stroyed by  the  kind  of  food  it  gets  at  home  at 
the  other  meals.    Properly,  therefore,  the  feed- 
ing of  children  should  be  made  part  of  a  much 
larger  social    program.      At    the  present    time 
there  are  in  New  York  twenty  schools,  register- 
ing 32,000  pupils,  where  tbe  lunch  system  is  op- 
erated.    The  need  for  such  a  service  was  natu- 
rally most  urgent  in  districts  where  the  people 
were  impoverished,   where  mothers  worked  in 
factories    by   day,  and   where  the  children  de- 
pended for  food  on  the  few  pennies  which  pur- 
chased candy  from  the.  vendors  about  school- 
hoases.    An  experiment  was  tried  in  the  equip- 
ment of  a  kitchen  in  a  school  building,  where 
soup,  sandwiches,  puddings  and  cocoa  were  pro- 
vided at  the  rate  of  one  cent  a  portion — ^the  child 
being  required  to  purchase  first  a  bowl  of  hot 
soup.   The  caloric  aggregates  of  some  of  the  typ- 
ical trays  of  food  provided,  the  price  of  none  of 
which  exceeds  a  total  of  three  cents,  are  given, 
and  these  are  samples  of  them : — 


Vegetable  soup... .     85.00 

Kgg  sandwich 23H.00 

Eice  pudding 108.76 


Bean  soup 111.27 

Bread,  two  slices.  200.00 
Prunes 180.00 


429.70 


491.27 


Aside  from  its  other  advantages,  the  school 
lunch  system  affords  an  admirable  opportunity 
to  teach  the  children  the  science  of  feeding,  in- 
cluding the  purchase,  preparation  and  hygiene 
of  food.  Fundamentally,  the  work  is  devoid  of 
any  mark  of  poor  relief.  During  the  last  school 
term  1,249,489  portions  of  food  were  sold;  for 


which  the  children  paid  $12,494.89.  The  service 
was  not  quite  self-supporting,  for  a  deficit  equal 
to  a  little  over  one-third  of  a  cent  per  portion 
was  incurred,  and  this  was  made  up  by  a  benevo- 
lent lady. 

Naturally,  in  any  scheme  for  feeding  large 
groups  of  children,  where  the  prime  object  is 
the  rearing  of  a  vigorous  race,  a  scientific  basis 
is  essential.    The  working  force  of  the  committee 
is  headed  by  a  dietitian,  who  is  responsible  for 
the  character  of  the  food  and  service,  and  the 
principles  on  which  food  is  selected  are:  (1)  nu- 
tritiousness,    (2)    palatability,    (3)    purity,    (4) 
seasonability,  (5)  inoffensiveness  to  racial  or  re- 
ligious preferences,  (6)  similarity  to  home  food, 
(7)  balance  in  accordance  with  food  principles. 
When  the  committee  is  assured  that  an  article 
of  diet  meets  with  these  requirements,  a  sample 
order  of  the  raw  product  is  secured,  and  it  is 
then  submitted  to  three  tests :  chemical,  bacterio- 
logical and  food  value.     Cooperation   with   the 
health  department  is  stated  to  have  yielded  the 
most  encouraging  results.     Analyses  have  been 
made  by  it,  and  also  by  some  of  the  university 
laboratories.    Furthermore,  health  authorities  in 
other  places  have  always  aided  when  asked  to 
inspect  the  manufactories  in  their  communities. 
Where  there  is  every  indication  that  the  product 
itself  is  pure,  the  place  where  the  food  is  manu- 
factured is  inspected,  and,  in  purchasing,  pref- 
erence is  given  to  firms  maintaining  the  best  con- 
ditions.    The  social  value  of  encouraging  trade 
where  decent  conditions  of  work  and  welfare 
prevail  is,  it  is  felt,  not  only  a  just  recognition 
of  good  public  service,  but  a  rebuke  to  the  manu- 
facturer who  thrives  on  adulteration,  over-work 
and  under-pay ;  and  here  one  recognizes  another 
measure  in  the  interest  of  public  health,  for  in 
the  degree  that  we  demand  livable  conditions  of 
labor  shall  we  secure  a  diminution  of  incapacity, 
sickness  and  death.    Where  foods  are  found  to 
contain  harmful  matter,  or  where  the  conditions 
of  manufacture  or  sale  are  unhygienic,  informa- 
tion is  laid  before  the  health   authorities  for 
action.     This  usually  prevents  the  further  dis- 
tribution of  a  product  which  is  likely  to  cause 
injury,    and  thus  there  is  an  educational  advan- 
tage in  this  system  which  can  scarcely  be  over- 
estimated.    An  additional  precaution  to  ensure 
the  purity  of  the  food  dispensed  is  the  careful 
scanning  of  the  lists  of  convicted  food  adulterers 
prepared  weekly  by  the  health  department.     Of 
course,   scrupulous   care   is  taken   to  have   the 
kitchen  and  service  equipment  entirely  hygienic, 


Vol.  CLXXII,  No.  13] 


BOSTON  MEDICAL  AND   BUROICAL  JOURNAL 


495 


and  in  order  to  prevent  the  possibility,  of  disease 
transmission  in  the  preparation  and  handling  of 
food,  the  committee  had  the  health  department 
make  a  thorough  physical  examination  of  all  the 
school  lunch  employees,  and  also  of  a  hundred 
children  who  assist  in  the  service.  The  argu- 
ment has  often  been  advanced  that  the  feeding 
of  children  at  school  causes  shiftless  parents  to 
shirk  their  just  share  of  responsibility  in  the 
nurture  of  their  offspring ;  but  this  has  not  been 
found  to  be  the  case.  On  the  contrary,  the 
school  lunch  employees,  coming  in  contact  with 
the  parents  in  the  districts,  are  often  consulted 
regarding  what  foods  to  prepare  for  children  at 
home,  and  how  to  prepare  them.  Certainly,  the 
New  York  School  Lunch  Committee  is  to  be  con- 
gratulated on  the  valuable  and  far-reaching 
work  it  is  accomplishing. 


Let  us  as  physicians  each  and  all  prepare  to 
do  our  parts  in  the  campaign  already  being 
waged  against  syphilis,  the  tragic  consequences 
of  which  we  know  full  well. 


THE  QUESTION  OF  QUARANTINE 
TRANSFER. 


SYPHILIS. 

We  wish  to  direct  the  attention  of  every 
reader  of  these  pages,  whether  man  or  woman, 
physician  or  layman,  to  the  article  by  Dr.  J. 
Harper  Blaisdell  which  is  printed  in  this  issue, 
under  the  title  of  "The  Menace  of  Syphilis  to 
the  Clean  Living  Public. ' ' 

There  is  no  doubt  that  many  persons  contract 
syphilis  innocently  and  that  many  more  are  ex- 
posed to  this  danger.  It  has  been  pointed  out 
that  even  those  who  lead  the  most  sheltered  livee 
are  not  free  from  this  menace. 

Must  the  innocent  always  be  thus  endangered, 
and  how  great  is  the  risk  t 

Before  answering  these  questions  a  store  of 
accurate  information  must  be  collected. 

Several  years  ago,  as  stated  by  Dr.  Blaisdell, 
New  York  City  made  syphilis  a  reportable  dis- 
ease with  this  end  in  view.  Statistics  as  to 
prevalence,  distribution,  and  source  of  infection 
in  a  community  must  prepare  the  way  for  effec- 
tive action. 

Is  it  known  how  many  syphilitics  there  are  in 
our  community,  how  many  of  them  daily  en- 
danger their  associates,  or  how  many  persons 
with  lesions  on  tlie  hands  are  engaged  in  the 
preparation  of  food? 

These  things  cannot  be  known  until  all  cases 
of  syphilis  are  reported  promptly  to  the  local 
health  authorities 


In  previous  issues  of  the  Journal  we  have, 
from  time  to  time,  commented  editorially  on  the 
relative  merits  of  federal  and  local  control  of 
(luarantine  service  and,  after  discussion,  have  ad- 
vocated the  transfer  of  the  Boston  Quarantine 
Station  from  municipal  to  national  administra- 
tion.    On  March  23  the  Boston  City  Council 
committee  on  ordinances  reported  favorably  on 
the  pending  plan  for  effecting  such  a  transfer, 
and  it  is  expected  that  the  necessary  ordinance 
will  ultimately  be  adopted  by  the  council.    At  a 
meeting  of  the  committee,  the  Boston  Chamber 
of  Commerce  submitted  a  further  report  in  whicli 
its    previous    opposition    to    the    transfer    was 
largely  withdrawn.     This  report  was  based  on 
a  previous  report  by  Mr.  Robert  Luce,  chairman 
of  a  special  committee  of  the  Chamber,  to  whom 
the  subject  was  referred.     Mr.  Luce's  report 
expressed  confidence   that  the   federal   govern- 
ment, in  the  event  of  transfer  can  be  relied  upon 
to   provide   adequate   accommodations   for   de- 
tained immigrants  and  that  the  officials  will  af- 
ford the  work  as  prompt  and  efficient  a  service 
as  that  which  it  at  present  enjoys.     The  final 
report  of  the  Chamber  further  calls  attention 
to  the  high  local  cost  of  maintaining  quarantine 
service  and  the  desirability  of  uniformity  in 
quarantine   administration    from   the   point   of 
view  both  of  public  health  and  of  the  commer- 
cial and  shipping  interests.     The  report  con- 
tinues as  follows; — 

"Furthermore,  there  appears  to  be  reason- 
able ground  for  the  expectation  that  in  the  near 
future  it  will  be  necessary  to  build  a  new  de- 
tention hospital  at  Gallop's  Island  or  elsewhere, 
and  it  is  averred  that  the  cost  thereof  may  run 
as  high  as  $250,000.  We  were  told  it  would  be 
possible  at  present  in  case  of  emergency,  to 
house  nearly  1000  persons  under  roofs  on  the 
island.  In  the  summer  more  could  be  maintained 
in  tents,  but  it  seems  clear  that  provision  ought 
to  be  made  for  winter  conditions. 

"If  the  United  States  takes  over  the  station, 
it  will  proceed  at  once  to  make  repairs  under  an 


496 


BOSTON  MEDICAL  AND   SUBOICAL  JOURNAL 


[APBn-  1,  1915 


annual  appropriation  available  for  the  service, 
and  will  proceed  at  once  to  aecquire  from  Con- 
gress funds  available  for  any  new  construction 
necessary.  ' 

"Manifestly  it  is  important  to  the  shipping 
interests  that  the  quarantine  station  be  adequate- 
ly provided  with  personnel  and  equipment  to 
handle  vessels  with  the  greatest  possible  expedi- 
tion in  ordinary  times,  and  the  least  possible  de- 
tention of  the  ship  itself  in  ease  infection  is 
found  aboard.  An  outbreak  of  plague  here 
would  paralyze  commerce  by  reason  of  attempts 
at  self -protection  on  the  part  of  other  ports. 

"Nothing  indicates  that  our  local  quarantine 
service  is  not  effective.  On  the  contrary,  it  is 
praised.  Yet  whatever  can  be  done  to  make  it 
still  more  effective  and  to  guard  against  every 
possible  contingency  would  seem  to  be  the  part 
of  prudence. 

"The  chief  weakness  of  the  present  arrange- 
ment appears  to  be  the  usual  weakness  that  fol- 
lows a  division  of  authority.  Under  normal  con- 
ditions, all  goes  well.  When  the  emergency 
comes  and  the  second  authority  steps  in,  then 
come  uncertainty,  misunderstanding,  friction, 
delay,  economic  loss,  danger  to  the  community. 
Unified  administration  lessens  these  chances  of 
injury,  and  in  that  particular  matter  brings 
about  certain  specific  advantages." 

As  the  result  of  this  reconciliation  of  the 
Chamber  of  Commerce  to  the  proposed  quaran- 
tine measure  it  is  earnestly  to  be  hoped  that  the 
transfer  of  the  Boston  Quarantine  Service  from 
local  to  federal  control  may  soon  be  effected. 


MISCELLANEOUS    MATTERS    OP    MEDI- 
CAL LEGISLATION. 

Before  the  Massachusetts  General  Court,  sev- 
eral measures  of  medical  legislation  upon  which 
comment  has  been  made  in  previous  issues  of  the 
Journal,  have  recently  been  acted  upon  as  fol- 
lows. The  anti-vaccination  bill  was  given  leave 
to  withdraw.  The  anti-vivisection  bill  was  de- 
feated by  the  House.  A  bill  was  reported  by 
the  committee  on  counties  authorizing  Barn- 
stable County  to  construct  and  maintain  a  hos- 
pital for  tuberculates.  The  public  health  com- 
mittee reported  favorably  the  bill  requiring  ap- 
plicants for  registration  in  medicine  to  be  grad- 
uates from  a  medical  school  approved  by  the 
State  Board  of  Registration  in  Medicine,  or  to 
possess  an  equivalent  training. 

The  text  of  this  important  bill  (House  No. 
745)  is  as  follows: — 


Section  three  of  chapter  seventy-six  of  the 
Revised  Laws  is  hereby  amended  by  inserting 
after  the  word  ' '  character, ' '  in  the  fifth  line,  the 
words : — and  a  graduate  of  a  legally  incorporated 
school  of  medicine, — so  as  to  read  as  follows: — 
Section  3.  Applications  for  registration  shall 
be  made  upon  blanks  to  be  furnished  by  the 
board,  and  shall  be  signed  and  sworn  to  by  the 
applicants.  Each  applicant  for  registration  shall 
furnish  satisfactory  proof  that  he  is  twenty-one 
years  of  age  or  over  and  of  good  moral  charac- 
ter and  a  graduate  of  a  legally  incorporate^ 
school  of  medicine,  and,  upon  payment  of  a  fee 
of  twenty  dollars,  shall  be  examined  by  said 
board.  If  he  is  found  by  four  or  more  members 
thereof  to  be  twenty -one  years  of  age  or  over,  of 
good  moral  character  and  qualified,  he  shall  be 
registered  as  a  qualified  physician  and  shall  re- 
ceive a  certificate  thereof  signed  by  the  chair- 
man and  secretary.  An  applicant  who  fails  to 
pass  an  examination  satisfactory  to  the  board, 
and  is  therefore  refused  registration,  shall  be 
entitled  within  one  year  after  such  refusal  to  a 
reexamination  at  a  meeting  of  the  board  called 
for  the  examination  of  applicants,  without  pay- 
ment of  an  additional  fee;  but  two  such  reex- 
aminations shall  exhaust  his  privilege  under  his 
original  application.  Said  board,  after  hearing, 
may  by  unanimous  vote  revoke  any  certificate 
issued  by  it  and  cancel  the  registration  of  any 
physician  who  has  been  convicted  of  a  felony 
or  of  any  crime  in  the  practice  of  his  profession. 
All  fees  received  by  the  board  shall,  once  each 
month,  be  paid  by  its  secretary  into  the  treasury 
of  the  commonwealth. 

The  committee  on  public  bealth  reported  ad- 
versely on  the  bill  and  recommendation  submit- 
ted by  the  State  Board  of  Registration  of 
Nurses.  This  recommendation  contained  in  the 
fifth  annual  report  of  the  board,  was  as  fol- 
lows : — 

"The  board  recommends  the  passage  of  an 
amendment  to  the  present  act  which  will  pro- 
vide for  the  registration  of  two  classes  of  nurses. 
The  title  R.N.,  meaning  registered  nurse,  author- 
ized for  nurses  who  are  graduates  of  approved 
training  schools,  and  who  can  meet  the  require- 
ments of  an  examination  which  would  determine 
the  fitness  of  a  nurse  to  do  any  work  a  nurse 
might  be  called  upon  to  do,  and  another  title, 
that  of  H.N.,  meaning  household  nurse.  Such 
nurses,  with  the  title  H.N.,  would,  under  this 
act,  be  permitted  to  take  care  of  ordinary  cases 
of  illness,  but  could  not  nurse  major  surgical 
cases. ' ' 

The  defeat  of  the  anti-vaecination  and  anti- 
vivisection  measures  is,  of  course,  cause  of  con- 
gratulation to  the  medical  profession.  It  is  per- 
haps best  that  the  bill  on  the  registration  of 
nurses  should  fail  to  pass  at  this  time.     It  may 


Vol.  CLXXII,  No.  13]  BOSTON  MEDICAL  AND  SURGICAL  JOURNAL 


497 


be  hoped  that  that  on  the  registration  of  physi- 
cians will  have  a  more  favorable  fate,  and  phy- 
sicians who  favor  it  should  write  to  their  repre- 
sentatives and  personally  attend  any  further 
hearings  upon  the  subject. 


MEDICAL  NOTES. 

Jordan  Memorial  Sanatorium. — The  recently 
published  second  annual  report  of  the  Jordan 
Memorial  Sanatorium,  River  Glade,  New  Bruns- 
wick, for  the  year  ended  October  31,  1914,  gives 
an  interesting  record  of  work  accomplished  in 
the  cure  and  arrest  of  tuberculosis.  The  num- 
ber of  patients  admitted  during  the  year  was 
87.  Of  this  number  six  were  discharged  as 
cured,  13  as  apparently  arrested  and  36  as  im- 
proved. 

Poliomyelitis  in  Dorsetshire. — In  a  recent 
issue  of  Public  Health,  Dr.  Rory  McLaren, 
public  health  officer  of  Dorsetshire,  England,  re- 
cords an  acute  epidemic  of  poliomyelitis  in  Bea- 
minster,  a  town  of  1700  inhabitants,  eight  miles 
from  the  English  Channel.  In  this  agricultural 
community  the  first  case  of  infantile  paralysis 
appeared  on  August  2,  1914.  Sixteen  other 
cases  followed  within  a  month,  all  within  a  mile 
and  a  half  of  the  center  of  the  village.  Six  of 
the  eases  died,  five  survived  with  serious  paraly- 
sis and  six  recovered  with  slight  disability.  This 
typical  severe  outbreak  conforms  definit^-ly  with 
the  infectious  character  of  the  disease  and  the 
probable  method  of  its  transmission  by  an  inter- 
mediate insect  host. 

AniRONDACK  Cottage  Sanitarium. — The  thir- 
tieth annual  report  of  the  Adirondack  Cottage 
Sanitarium,  Saranac  Lake,  N.  Y.,  contains  a 
carefully  detailed  and  interesting  record  of  the 
work  of  that  institution.  Of  the  229  patients 
treated  during  the  year,  20.5%  were  discharged 
apparently  cured,  43.7%  were  discharged  with 
disease  arrested,  and  11%  improved.  The  total 
contributions  for  the  year  amounted  to  $63,- 
620.67;  contributions  to  the  general  fund 
amounted  to  $14,432.71;  to  the  x-ray  account, 
$3,100.00. 

Increasing  Death-Rate  from  Organic  Dis- 
ease.— The  Life  Extension  Institute  of  New 
York  has  recently  issued  in  pamphlet  form  an 
address  by  its  president,  Elmer  E.  Rittenhouse, 
entitled  "America's  Pressing  Mortality  Prob- 
lem." Accompanying  the  text  is  a  series  of 
charts  showing  graphically  the  rapid  increase 
of  deaths  from  apoplexy,  kidney  and  urinary 
disease  and  cardiac  and  circulatory  disease  in  the 
United  States  and  a  corresponding  decrease  of 


deaths  from  these  causes  in  England  and  Wales. 
In  concluding  his  discussion  of  these  facts, 
the  author  states,  as  his  solution  of  this  problem, 
that  education  in  indi^adual  hygiene  is  the 
remedy  for  these  alarming  conditions  and  the 
ultimate  means  by  which  length  and  efficiency 
of  life  may  be  attained. 

Typhus  in  Serbia. — It  is  reported  by  the  war 
relief  committee  of  the  Rockefeller  Foundation, 
on  its  return  from  a  tour  of  inspection  through 
Serbia,  that  typhus,  typhoid  fever,  cholera, 
smallpox,  diphtheria,  scarlet  fever,  and  recurrent 
fever  are  all  existing  in  epidemic  form.  Typhus, 
the  most  deadly  of  these,  already  has  caused  the 
death  of  60  out  of  400  native  doctors  of  the 
country.  The  foreign  Red  Cross  units  have  suf- 
fered great  losses.  Two  American  units  and  one 
British  have  been  compelled  to  suspend  their 
regular  work  because  of  typhus.  Nine  American 
nurses  and  two  physicians  have  contracted  the 
disease.  The  Serbians  assert  that  Austrian  pris- 
oners of  war  who  were  permitted  to  wander  over 
the  country,  introduced  the  disease  and  infected 
the  population. 

Annual  Report  op  the  Craig  Colony  for 
Epiijiptics. — In  presenting  their  annual  report 
to  the  Legislature  of  the  State  of  New  York,  the 
board  of  managers  of  the  Craig  Colony  for  Epi- 
leptics, Sonyea,  N.  Y.,  make  the  following  state- 
ment : — 

"On  September  30,  1913,  the  census  was 
males,  763 ;  and  females,  664,  total  1,427.  There 
were  admitted  during  the  year  125  males,  86 
females;  total  211.  There  were  discharged  dur- 
ing the  year  136  males  and  81  females,  a  total 
of  217,  making  the  census  on  September  30, 1914, 
752  males  and  669  females;  total  1,421.  From 
the  time  of  the  vaccination  against  typhoid 
fever  of  all  employees  and  patients  in  the  infirm- 
ary in  1912,  no  cases  of  this  disease  developed 
until  in  September,  1914,  when  three  cases  were 
diagnosed.  It  is  believed  that  a  carrier  was  the 
source  of  infection.  The  number  of  patients  in 
the  colony  having  tuberculosis  approximates 
200." 

As  is  usual  the  report  contains  an  interesting 
record  of  autopsies  performed  on  87  patients. 

Nebraska  Orthopedic  Hospital. — The  senr- 
enth  biennial  report  of  the  Nebra.ska  State  Board 
of  Charities  and  Correction  contains  an  interest- 
ing account  of  the  Orthopedic  Hospital  main- 
tained by  that  state.  Since  its  establishment  in 
1905,  it  has  treated  nearly  1,000  patients.  A 
new  building  for  its  use  is  in  process  of  comple- 
tion and  when  finished  will  increase  the  capacity 
of  the  hospital  to  150  patients  and  make  it  one 
of  the  largest  strictly  orthopedic  hospitals  in  this 
country.  Its  record  for  the  two  years  beginning 
November  30,  1912  is  690  patients  received,  279 
discharged  as  cured,  258  discharged  as  benefited, 
30  discharged  as  not  improved  and  16  deaths. 


498 


BOSTON   MEDICAL  AND   SURGICAL   JOURNAL 


[April  1,  1915 


Annual  Report  of  the  Battle  Ceeek  Sani- 
tarium.— The  recently  issued  report  of  the  Bat- 
tle Creek  Sanitarium,  Battle  Creek,  Mich.,  for 
the  year  1913  shows  a  steadily  increasing  num- 
ber of  patients  attending  this  institution  and  a 
constant  broadening  of  the  field  of  work  here 
attempted.  Since  its  incorporation  in  1876,  the 
number  of  patients  treated  has  risen  from  182 
in  that  year  to  5,693  in  1913.  Improvements  in- 
volving the  expenditure  of  more  than  $50,000 
were  made  during  the  year.  An  advance  in  the 
work  of  the  institution  was  initiated  by  the  ap- 
pointing of  a  committee  to  organize  and  equip 
a  children's  ward.  In  1913  the  number  of  pa- 
tients aged  15  years  or  under  was  176,  the 
average  number  being  17.6. 

In  the  first  week  of  January,  1914,  a  Race 
Betterment  Conference  was  held  at  the  sani- 
tarium, the  expenses  of  the  movement  being 
borne  by  the  Race  Betterment  Foundation,  a 
philanthropic  association  which  is  closely  allied 
to  the  sanitarium  and  which  undertakes  the 
support  of  numerous  lines  of  philanthropic  work 
directly  or  indirectly  connected  with  it. 

European  War  Notes. — On  March  27,  the  to- 
tal of  the  New  York  Belgian  relief  fund 
amounted  to  $995,579.59;  the  American  Jewish 
relief  fund  to  $579,996.53;  the  New  York  Red 
Cross  fund  to  $475,350.34 ;  the  New  York  Com- 
mittee of  Mercy  fund  to  $137,523.71 ;  the  New 
York  Polish  relief  fund  to  $28,916.92;  and  the 
New  York  Serbian  relief  fund  to  $25,217.00. 

On  March  28  the  total  of  the  New  England 
Belgian  relief  fund  amounted  to  $238,503.92; 
the  Massachusetts  Red  Cross  fund  to  $116,-, 
495.40 ;  the  Boston  branch  of  the  American  Am- 
bulance Hospital  fund  to  $56,348.25 ;  the  Boston 
Polish  relief  fund  to  $38,775.87 ;  and  the  Boston 
branch  of  the  Prince  of  Wales  fund  to  $12,- 
500.00. 

boston  and  new  ENGLAND. 

Eugenic  Law  in  Vermont.— Report  from 
Montpelier,  Vermont,  states  that  on  March  22 
the  Legislature  enacted  the  so-called  eugenic 
marriage  law  providing  a  fine  of  $500.  for  any 
person  who  marries  without  a  physician's  cer- 
tificate of  physical  and  mental  fitness. 

Massachusetts  District  Health  Officers. — 
Notice  was  issued  by  the  Massachusetts  State 
Department  of  Health  on  March  23  that  the 
eight  new  district  health  officers  recently  ap- 
pointed by  Dr.  McLaughlin  are  to  begin  their 
duties  April  1.. 

IMiLK  and  Baby  Hygiene  Association. — The 
sixth  annual  meeting  of  the  Boston  Milk  and 
Baby  Hygiene  Association  was  held  in  this  city 
on  March  23  under  the  presidency  of  Dr.  Charles 
W.  Eliot.  The  principal  address  was  by  Dr. 
S.  Josephine  Baker  on  ' '  The  Community  and  the 
Baby."      The    annual    report    of    the    director 


showed  that  during  the  past  year  4,097  babies 
were  treated  at  the  12  milk  stations  maintained 
by  the  association,  whose  nurses  made  also  50,- 
275  visits  to  patients  in  the  latter 's  homes. 

Organization  of  the  East  Boston  Medical 
Association. — On  March  19,  a  number  of  physi- 
cians of  East  Boston  met  and  organized  the  East 
Boston  Medical  Association.  The  following  offi- 
cers were  elected:  Dr.  Frank  Tilton,  president; 
Dr.  Robert  Barney,  vice-president;  Dr.  A.  L. 
McLaren,  treasurer,  and  Dr.  J.  D.  Taylor,  secre- 
tary. 

Epizootic  of  Foot  and  Mouth  Disease. — At 
the  Westboro  Lyman  School  61  hogs,  valued  at 
$877,  were  found  to  be  infected  with  foot  and 
mouth  disease  following  an  attack  of  hog  cholera, 
and  were  slaughtered.  A  herd  of  70  cows  kept 
near  the  hogs  showed  no  signs  of  the  disease. 

Massachusetts  Homeopathic  Hospital. — 
The  recently  published  annual  report  of  the 
Massachusetts  Homeopathic  Hospital  states  that 
during  the  year  ended  December  31,  1914,  23,- 
260  patients  were  treated  in  the  various  depart- 
ments of  the  institution,  an  increase  of  808  over 
the  previous  year.  In  the  wards  of  the  Main 
Hospital  there  were  treated  6,533  patients  as 
compared  with  6,508  a  year  ago.  At  the  Haynes 
Memorial  there  were  treated  838  patients  as 
compared  with  455  patients  a  year  ago.  The  fol- 
low up  system  of  the  hospital  has  been  enlarged 
and  a  social  service  worker  engaged.  The  meth- 
ods of  fire  protection  over  the  hospital  have  been 
improved,  $3,442.89  being  expended  for  this  pur- 
pose. The  report  also  contains  a  picture  of  the 
new  maternity  and  out-patient  building  in  pro- 
cess of  erection,  which  will  greatly  facilitate  the 
work  of  these  departments. 

Lawrence  General  Hospital. — The  thirty- 
ninth  annual  report  of  the  Lawrence  General 
Hospital,  Lawrence  Mass.,  conducted  by  the 
Ladies'  Union  Charitable  Society  of  that  city, 
for  the  year  ended  September  30,  1914,  shows 
that  institution  to  be  in  a  commendable  state  of 
efficiency.  The  total  number  of  patients  ad- 
mitted to  the  hospital  during  this  period  was 
1833.  The  out-patient  department  treated  1679 
patients,  and  the  orthopedic  department,  558. 
The  maximum  number  of  patients  in  any  one 
day  was  93  and  the  minimum  46. 

On  October  8,  1914,  Sarah  Frances  Shackford, 
the  last  survivor  of  the  charter  members  of  the 
Ladies'  Union  Charitable  Society,  died  at  her 
home,  al  the  age  of  75.  She  was  at  that  time 
president  of  the  society,  having  served  contin- 
uously, in  one  office  or  another,  since  the  organi- 
zation of  the  society  in  1875. 

The  hospital  has  been  enlarged  by  the  addition 
of  a  children's  ward,  the  gift  of  Mr.  Joseph 
Shattuck,  and  plans  are  drawn  up  for  another 
building  to  be  used  as  a  nurses'  home. 


Vol.  CLXXII,  Xo.  13] 


BOSTOX  MEDICAL  ASD   SURGICAL   JOIRXAL 


499 


New  England  Baptist  Hospital. — The 
twenty-first  annual  report  of  the  New  England 
Baptist  Hospital,  Boston,  for  the  year  ended 
December  31,  1914,  shows  that  during  the  year, 
712  patients  were  admitted.  Of  this  number  105 
received  medical  treatment,  499  surgical  treat- 
ment and  70  were  maternity  cases. 

The  president  of  the  corporation  states  in  his 
report : 

"The  year  just  closed  has  been  one  of  the 
most  interesting  in  our  history  from  every  point 
of  consideration.  Our  service  to  the  community 
has  been  the  largest,  our  receipts  from  all  sources 
have  been  very  materially  increased,  the  amount 
of  free  service  has  been  much  larger  than  any 
year,  with  one  exception,  and  the  number  of 
major  surgical  cases  has  been  more  than  doubled, 
as  compared  with  former  years,  with  a  very 
gratifying  low  percentage  of  deaths." 

Cases  op  Infectious  Diseases  reported  to  the 
Boston  Board  of  Health  for  the  week  ending 
March  23, 1915 :  Diphtheria,  66,  of  which  3  were 
non-resident;  scarlatina,  48,  of  which  7  were 
non-resident;  typhoid  fever,  6,  of  which  1  was 
non-resident ;  measles,  177,  of  which  2  were  non- 
residfflit;  tuberculosis,  53,  of  which  3  were  non- 
resident. The  death-rate  of  the  reported  deaths 
for  the  week  was  19.12. 


QIarrrB|iondrnrr. 


PARIS  LETTER. 
iFron  Ow  Spteial  Corretpomlent.t 

Ttphotd  FIveb  in  thk  Westebn  Ascra  of  Wab. 

Pakis,  March  13,  1916. 

Mr.  Editor:  in  casting  about  In  my  mind  for  a 
heading  to  this  letter  I  remembered  the  title  of  a 
book  said  to  have  once  really  existed:  "English  As 
She  Is  Spoke."  So  I  propose  to  place  as  a  super- 
scription to  the  following  remarkable  document  the 
delightfully  ungrnmmatlcal  sentence:  "Tj-phold  fever 
as  she  should  not  be  took-care-of !" 

In  my  last  letter  I  referred  to  the  universal  dis- 
satisfaction manifested  here  as  regards  the  care  of 
the  sick  and  wounded  from  the  fightlng-Unes.  The 
main  defence  of  the  Service  de  Sant6  is  that  they 
have  been  utterly  swamped  by  the  number  of  men  to 
be  handled,  which  has  proved  to  be  in  the  proiwrtlon 
of  Ave  to  two,  as  regards  the  number  they  expected 
to  handle  and  for  which  they  had  made  provision. 
I  also  cited  the  somewhat  peppery  remark  which  a 
deputy  claimed  to  have  made  to  the  director  of  this 
health  service.  Today  I  think  I  will  give,  nearly  In 
full,  a  letter  received  from  one  of  the  temporary  hos- 
pitals, to  show  that,  perhaps,  this  deputy's  sentiments 
were  not  altogether  unjustified.  When  the  war  had 
been  going  on  a  few  months,  and  the  authorities  saw 
that  their  antiquated  nursing-system  was  giving  such 
deplorable  results,  they  decided  to  incorporate  quite 
a  body  of  properly-trained  nurses  from  England  into 
their  sanitary  formations,  in  the  hope  in  this  manner 
to  leaven  the  entire  lump  of  dough :  arrangements 
were  consequently  made  for  the  gradual  moving  across 


the  Channel  of  three  hundred  of  these  women,  to  be  as 
picked  a  body  as  was  possible  under  the  present  tight 
circumstances,  the  Idea  being  to  distribute  them  about 
among  the  military  hospitals  in  little  groups  of  four 
or  five.  The  results  of  this  move  might  really  have 
been  foreseen !  The  French  voluntary  organizations 
of  amateur  nurses, — who  after  all  had  been  doing 
their  very  best,  naturally,- — were  stung  to  the  quick 
at  this  aspersion  on  their  capabilities;  they  "saw 
red,"  as  the  expression  goes,  and  in  many  places  made 
the  life  of  the  English  invaders  a  mild  little  kind  of 
sheol,  in  which  line  of  action  they  were  often  backed 
up  by  the  medleal  attendants.  So  now  the  plan  has 
been  modified,  and  the  endeavor  is  being  made  to 
place  these  nurses  in  groups  by  themselves,  in  such  a 
was  as  practically  to  give  them  entire  charge  of  the 
patients  of  whom  they  have  the  care.  Among  the 
first  of  these  nurses  to  come  over  was  an  old  friend 
of  mine,  a  very  bright  woman  of  wide  experience,  and 
the  following  is  the  letter  she  wrote  me  soon  after 
reaching  her  post.  Comment  on  It  is  unnecessary, 
I  will  merely  add  that  another  nurse,  to  whom  I 
showed  this  letter,  tells  me  that  she  has  seen  a 
typhoid  hospital  of  nearly  one  thoumnd  cases,  with 
fwndltlons  similar  to  these.  I  certainly  am  devoutly 
thankful  that  I  have  no  son  In  this  war.  If  I  had. 
I  might,  jierhaps,  stand  with  fortitude  his  being  killed 
in  battle  for  his  country's  ltl)eratlon ;  but  what  would 
not  be  bearable  would  be  to  have  his  life  played  with 
In  thi»  fashion. 

"I  am  afraid  you  would  be  quite  overcome  by  the 
awfulness  of  this  place ;  It  is  a  veritable  pest-house 
we  have  got  to,  this  time.  There  are  eighty  patients 
in  all,  and  oh !  what  a  desperate  state  they  are  in ! 
This  is  only  a  temi>orar.v  hospital,  formerly  a  school, 
and  the  sick  men  are  distributed  about  In  different 
rooms.  I'p  to  the  time  of  our  coming  there  were  only 
two  real  orderlies  for  medicine,  temperature,  hypo- 
dermics and  cupping,  two  for  giving  the  lotions,  a 
sort  of  cross  between  a  tub  and  a  sponge,  two  for 
oarrying  up  the  foo<l,  and  one  on  at  night.  You  can 
half  Imagine  the  state  we  found  the  poor  souls  in. 
I'p  to  three  weeks  ago  the  wounded  were  brought 
here:  but  now  it  is  only  for  the  worst  cases  of  ty- 
phoid. There  Is  a  pump  in  the  courtyard,  and  some 
warm  water  in  the  kitchen  stove  at  times;  but  there 
is  not  a  tap  in  the  place,  and  every  drop  of  water 
must  be  carried  ui>stalrs.  The  carrying  would  not 
be  80  bad,  if  we  only  had  something  to  carry  in ; 
there  la  only  one  Jug  in  the  whole  place'  (2V6  litres), 
and  although  we  ask,  and  are  promised,  we  have  not 
received  anything  further  yet  except  five  hygienic 
palls  (there  was  only  one  when  we  arrived).  There 
lire  just  five  basins  for  washing  the  patients, — five 
for  eighty  men !  And  not  a  pillow  In  the  whole  hos- 
pital, only  little  bol.sters.  There  were  only  eight 
spitting-cups, — the  men  have  been  using  the  floor  up 
to  now;  but  by  agitating  we  have  been  supplied  with 
twenty  condensed  milk  cans  for  this  use.  There  la 
only  one  chair  in  each  ward,  and  no  bed-tables;  so 
mugs,  cups,  everything  goes  on  the  floor,  which  i? 
black,  ■  never  scrubbed,  only  sprinkled  with  carbolic, 
ns  they  do  In  the  Paris  Metro,  and  then  swept  with 
a  wet  broom,  thereby  grinding  the  dirt  into  the 
grain  of  the  wood.  The  windows  do  not  appear  to 
have  been  cleaned  since  the  building  was  put  up, 
some  fifty  years  ago.  There  is  no  place  yet  provided 
for  disinfecting  linen.  I  keep  begging  for  formol,  but 
apparently  it  is  considered  too  costly.  The  mattresses 
are  all  old  ones  from  the  barracks,  straw  and  lumps 
of  wadding,  all  more  than  filthy  and  smelling  fright- 
fully, as  you  will  understand  when  I  tell  you  that 
they  do  not  own  such  a  thing  as  a  rubber  drawsheet. 
The  men  seem  so  surprised  when  we  want  to  change 
a  sheet  after  an  Involuntary  motion !  The  patients 
have  been  allowed  to  walk  out  of  the  rooms  to  the 
w.  c,  whether  tottering  and  delirious  or  not,  and 
when  they  are  to  have  a  lotion  the  orderlies  have 
been  making  them  leave  their  beds  naked,  go  to  the 
middle  of  the  ward,  and  lay  themselves  down  on  a 


500 


BOSTON  MEDICAL  AND   SURGICAL  JOURNAL 


[Afbil  1,  1915 


cold  wet  sheet  arranged  over  an  India-rubber  sheet 
on  an  ordinary  stretcher.  The  lotions  are  ordered 
two,  three  or  four  times  a  day,  and  never  at  night, 
regardless  of  temperature,  which  is  never  taken  of- 
tener  than  twice  a  day.  Nearly  every  patient  gets 
quinine,  and  most  of  them  are  quite  deaf  from  it. 
B-naphthol,  aspirin,  and  cinchona  vpine  are  the  regu- 
lation remedies,  together  with  two  kinds  of  hypo- 
dermics, cafifein  and  camphorated  oil, — a  man  up  and 
about  may  be  ordered  a  hypo  of  camphorated  oil ! 

"When  we  first  got  here  we  all  of  us  stayed  on  duty 
all  night,  to  try  and  clean  up  the  patients  and  make 
their  beds.  The  men  say  one  and  all  that  they  have 
not  been  washed  for  three  weeks,  or  had  their  beds 
made.  You  cannot  Imagine  what  an  awful  state 
their  mouths  are  in.  I  came  on  regular  night  duty  on 
Sunday,  and  began  with  a  death,  a  poor  lad  of  only 
eighteen.  I  may  say  that  the  doctor  is  never  to  be 
sent  for;  he  just  comes  once  or  twice  a  day,  and  lives 
In  the  town.  This  poor  boy  died  in  full  view  of  all 
the  patients,  such  a  thing  as  a  screen  being  unheard- 
of  here,  and  after  he  died  two  orderlies  just  carried 
him  away  to  the  attic.  As  they  were  doing  this  a 
delirious  man  left  his  bed  and  was  fumbling  at  the 
door,  so  that  the  orderlies  had  to  put  down  the 
stretcher  with  the  body  on  the  landing  and  secure 
the  wanderer.  In  the  meantime  several  other  patients 
were  going  to  and  from  the  w.  c.  and  had  to  step  over 
the  corpse.  It  Is  all  so  gruesome,  and  so  frightfully 
unhealthy, — little  better  than  a  pesthouse.  The  w.  c. 
Is  on  each  landing,  in  full  view,  and  consists  of  a 
wine-vat  cut  in  half  with  a  board  across  for  a  seat; 
they  are,  of  course,  in  almost  constant  requisition! 

"I  cannot  possibly  continue  for  long  in  these  condi- 
tions, with  only  one  orderly  to  help  me  at  night.  We 
are  also  always  short  of  disinfectant.  If  you  could 
see  me  in  this  ward,  with  ten  delirious  cases,  others 
coughing  all  the  time,  and  others  muttering!  One 
feature  about  these  men  Is  curious,  there  seem  to  be 
so  few  bad  hemorrhages;  I  wonder  whether  that  can 
depend  on  the  fact  that  many  of  them  were  inocu- 
lated on  reaching  the  hospital?  The  majority  are 
very  serious  cases,  with  bronchopneumonia,  or 
pleurisy."  "  s." 


FIELD  SURGERY  ON  THE  POLISH 
BATTLEFRONT.* 

Kembung,  December  4,  1914. 
Russian  Poland  near  Lodz. 
I  am  still  aUve  in  spite  of  being  now  four  months 
in  war.  You  can  hardly  imagine  how  sorry  I  was 
when  I  understood  at  that  ominous  Saturday,  1st  of 
August,  that  I  could  not  see  you  any  more.  For 
years  and  months  I  was  looking  forward  with  joy 
and  happiness  to  seeing  you  at  my  house,  and  to 
having  you  for  several  days  In  Berlin,  and  then  you 
were  in  Berlin  and  I  could  not  even  see  you.  The 
four  months  following  that  day  were  the  most  event- 
ful of  my  life.  Right  away  I  was  called  to  the  front 
and  was  happy  to  follow  and  to  obey  this  call.  At 
first  for  about  two  weeks  I  was  captain-surgeon  in  an 
old  and  famous  dragoon  regiment  in  Allenstein.  There 
it  was  my  duty  to  examine  all  the  young  and  old  fel- 
lows who  wished  to  enter  voluntary  service.  The 
court  of  the  barracks  was  day  by  day  crowded  with 
men,  not  only  with  working  men,  but  mostly  vrtth  men 
of  the  upper  classes.  The  enthusiasm  was  simply  tre- 
mendous. It  was  impossible  to  take  them  all,  al- 
though they  Insisted  and  begged,  considering  it  as  the 
greatest  misfortune  of  their  lives  that  they  had  not 
been  able  to  be  enlisted.  Besides  this  business  of  ex- 
amining I  had  to  vaccinate  all  the  soldiers  of  my 
regiment.  You  can  Imagine  that  this  kind  of  work 
did  not  please  me  for  a  long  time  and  after  trying  a 

*  Letter  from  Dr.  M.  BShtn,  former  director  of  the  Medico-Me- 
chanical Department  of  tile  Mai«achusetts  General  Hospital,  to  Dr. 
K.  B.  Osgood,  of  Boston. 


while  I  got  another  kind  of  work  more  like  my  spe- 
cialty. I  became  captain-surgeon  at  a  field  hospital. 
Now  I  could  work  surgically  and  soon  I  went  to  the 
battle  fields.  My  first  experiences  were  at  the  little 
battle  of  Bialla,  near  the  Russian  frontier;  they  con- 
cerned, however,  a  very  small  number  of  wounded 
men,  Germans  and  Russians.  However,  a  few  weeks 
later  during  the  last  week  of  August,  I  had  the  great 
luck  of  participating  at  the  great  battle  of  Tannen- 
berg.  I  do  not  know  how  much  you  are  informed  of 
the  events  of  this  war,  but  surely  you  will  know  this 
tremendous  historical  event,  one  of  the  greatest  victor- 
ies of  this  war,  where  a  relatively  small  German  army 
captured  a  much  bigger  Russian  army.  Two  weeks 
afterward  I  took  part  in  the  second  great  East  Prus- 
sian battle  "at  the  Masurian  Lakes."  The  numbers 
of  wounded  men,  both  German  and  Russian,  were 
overwhelming.  We  worked  for  weeks,  day  and  night, 
at  our  field  hospital.  Besides  this  I  had  the  special 
order  after  Tannenberg  to  take  charge  of  one  big 
Russian  field  hospital  captured  at  Hohenstein.  The 
work  of  a  field  surgeon  is  nowadays  quite  different 
from  what  it  was  formerly.  Whoever  expects  to  do 
great  operations,  amputations,  excisions,  etc.,  will  be 
greatly  disappointed.  Conservative  surgery  is  tri- 
umphing. I  mean,  of  course,  right  away  on  the  field 
and  at  the  field  hospital.  Well  adapted  bandages, 
good  fixation  of  the  damaged  joints  and  bones,  plas- 
ters, and  splints, — that  is  the  point  of  field  surgery, 
and  not  only  of  surgery  of  the  extremities,  but  also  In 
abdominal  surgery  it  is  much  better  not  to  operate  In 
the  field  but  later  in  the  so-called  "reserve  hospitals," 
which  are  located  near  the  boundary  in  a  rather  safe 
region.  Therefore,  again  transportation  plays  an  emi- 
nent rSle  in  modern  war  and  motor  cars  are  of  tre- 
mendous use  for  war-sanitary-purposes.  I  presume 
that  the  triumph  of  conservative  surgery  in  this  war 
will  be  of  eminent  advantage  for  orthopedic  surgery 
after  the  war.  The  two  above-mentioned  battles  liber- 
ated East  Prussia  entirely  from  the  Russian  Invasion, 
at  least  for  several  weeks  and  our  army  was  free  to 
enter  Poland.  The  first  expedition  into  Poland  In 
which  I  participated  went  over  Czenstochava,  Radow, 
until  very  near  Varsovie,  capital  of  Poland.  It  was  a 
march  of  tremendous  laborlousness,  the  weather  be- 
ing rainy  and  cold  during  all  the  days,  the  streets 
of  Poland  being  in  an  unheard-of-condition,  our  horses 
being  in  morasses  sometimes  over  their  knees,  and 
still  we  did  not  lose  a  single  horse  or  wagon  of  our 
field  hospital,  and  reached  Warnhau  or  Varsovie,  i.e. 
the  neighborhood  of  this  city,  in  less  than  twelve  days, 
marching  day  and  night  with  very  little  rest. 

Nobody  knows  yet,  with  surety,  what  the  idea  of 
this  quick  march  was  and  what  the  task  of  the  re- 
turn march  has  been  which  was  made  soon  after- 
ward. Surely  it  was  not  a  flight,  for  we  marched  out 
of  Poland  more  slowly  than  we  marched  towards  Var- 
sovie and  surely  the  whole  business  was  Intended  by 
our  chief  generals.  For  as  soon  as  we  entered  Poland 
and  we  progressed,  I  had  the  exact  order  to  send  the 
wounded  back  to  the  frontier  and  not  to  treat  them 
here.  And  every  treatment  had  to  be  as  fast  as  pos- 
sible. For  instance,  in  Grojeo,  a  little  town  near 
Varsovie,  I  had  to  bandage  450  men  in  one  day  and 
night.  In  order  to  fit  them  for  transportation.  The 
whole  month  of  October  we  spent  in  Poland.  As  soon 
as  we  returned  to  Germany  orders  came  for  a  second 
invasion  into  Poland  from  another  point  of  the 
frontier.  And  now  for-  three  weeks  our  troops  stand 
near  Lodz,  after  having  had  some  victorious  battles 
on  their  way  from  Germany.  We  expect  that  these 
battles  now  will  bring  us  the  decision  not  only  of  the 
war  against  Russia,  but  of  the  entire  war.  It  is  true  the 
Russians  are  much  more  nimierous  than  we  are,  but 
this  fact  so  far  during  the  war  was  not  of  so  great 
importance,  the  Russians  thought.  To  my  mind  it 
shows  enough  the  minor  quality  of  the  Russian  army, 
that  they  were  not  able  to  carry  war  for  any  length 
of  time  Into  Germany.  The  point  is, — and  that  I 
have  a  hundred  proofs  for,— the  Russian  soldier  has 


Vol.  CI^XXII,  Xo.  13] 


BOSTON  MEDICAL   ASD   SVROICAL  JOURyAL 


501 


no  idea  what  he  Is  fighting  for.  You  ask  the  cap- 
tured and  wounded, — and  I  have  seen  thousands, — 
whether  they  would  like  to  return  to  their  army  if  I 
dismiss  them  and  they  all  will  beg  you  to  keep  them. 
They  all  have  a  kind  of  stupid  energy,  but  no  Intelli- 
gent enthusiasm  whatsoever.  Lately,  during  the  last 
fights,  the  wounded  Kussians  were  often  drunk.  It 
seems  that  alcohol  is  used  to  drive  them  Into  the 
front.  I  personally  believe  we  shall  master  the  Rus- 
sians In  a  relatively  short  time.  Whether  this  means 
the  end  of  the  war,  that,  of  course,  depends  largely 
upon  other  factors,  particularly  upon  England.  This 
is  the  most  interesting  moment  In  this  war.  Of 
course,  you  probably  have  your  own  opinion  on  this 
question  and  you  will  read  in  your  papers  and  also 
In  our  papers  great  discussions  upon  the  cause  of  the 
war.  It  is  a  pity  to  waste  so  much  Ink  on  this  ques- 
tion. Nobody  Is  the  cause,  history  is  the  cause,  gen- 
eral world  conditions  have  brought  It  about. 

I  am  afraid  I  have  bored  you  too  much  with  my 
talk.  I  have  had  four  free  days,  living  in  a  lonely 
Polish  peasant  house, — that  may  be  my  excuse.  The 
purpose  of  my  letter  has  originally  not  been  to  give 
you  a  political  expose,  but  simply  to  send  yon  my 
heartiest  greetings  and  wishes  for  Christmas  and  New 
Year.  I  beg  you,  since  I  am  unable  to  write  Chri.st- 
mas  cards,  to  give  my  regards  to  all  my  old  good 
Boston  friends,  and  my  heartiest  wishes  and  greet- 
ings from  your  old  BShm. 

V.S.  If  you  know  what  It  means  it  might  Interest 
you  that  since  the  battles  In  East  Prussia  I  am  "a 
knight  of  the  Iron  cross." 


QUESTIONS    ABOUT   THE    HARRISON   LAW. 
Boston,  March  16,  1915. 

Mr.  Editor:  The  new  Federal  law  In  regard  to  the 
dispensing  of  opium,  the  Harrison  law,  apparently 
imposes  what  I  consider  a  dangerous  limitation  on 
doctors.  For  many  years  I  have  demanded  that  the 
druggist  should  write  on  the  box  a  copy  of  any  pre- 
scription which  contained  opium.  This  I  consider  a 
safeguard  to  the  patient,  and  a  help  to  the  doctor. 
I  have  followed  this  practise  since  I  knew  of  a  case 
in  which  a  mother  gave  a  one-fourth  grain  morphine 
suppository  to  an  infant  to  move  the  bowels. 

1  recently  criticized  a  reliable  druggist  who  did  not 
follow  my  directions,  and  was  told  that  the  Harrison 
law  forbade  such  a  practise. 

It  seems  wise  that  tie  Boston  Medical  and  Sdboi- 
CAi^  Journal  should  ask  for  a  ruling  on  this  question 
from  Washington.  Resi)ectfully, 

Henby  Jackson,  M.D. 
March  17,  1916. 

Mr.  Editor:  Since  writing  the  above,  two  druggists 
say  they  consider  it  proper  to  put  the  prescription  on 
the  box.  They  quote  the  rulings  on  proprietary  medi- 
cines which  demand  this  practise.       Truly, 

Henry  Jackson,  M.D. 

[Note. — There  is  nothing  in  the  Federal  law  which 
prohibits  the  prescription  from  being  written  upon 
the  label  of  the  container.  The  State  law,  however, 
provides  that:  "The  prescription  shall  not  be  copied 
except  for  the  purpose  of  record  by  the  druggist 
filling  the  same." 

There  is  nothing  In  either  law  which  prohibits  the 
proscriber  from  giving  whatever  information  or  di- 
rection he  may  deem  necessary  for  his  patient  to 
have;  and  if  he  thinks  It  is  best,  he  can  direct  that 
the  amount  of  narcotic,  which  the  prescription  con- 
tains, shall  be  clearly  stated  upon  the  label.  This 
can  be  done  without  a  copy  being  made, 

The  following  rules  Interpreting  the  Harrison  Law 
have  recently  been  Issued  by  the  collector  of  internal 
revenue,  port  of  Boston  and  are  reprlntpd  here  for 
the  further  aid  and  guidance  of  physicians. 


"A  physician,  registered  under  the  law,  must  keep 
a  record  of  the  drugs  disi)ensed,  distributed  or  admin- 
istered by  him  in  his  otlice.  A  record  is  also  required 
to  be  kept  of  those  drugs  left  with  a  patient  to  be 
taken  In  the  physician's  absence.  No  record  is  re- 
quired to  be  kept  of  those  drugs  personally  adminis- 
tered by  the  physician  to  the  patient  when  away  from 
his  office. 

I  "A  physician  or  dentist  who  usee  only  minute  quan- 
!  titles  of  drugs  affected  by  the  act,  such  as  oculists, 
aurists  and  other  specialists,  may  keep  a  record  of 
the  date  when  a  stock  solution  is  made  and  the  date 
when  such  stock  solution  is  exhausted,  without  keep- 
ing a  record  of  the  name  and  address  of  each  patient 
to  whom  such  drugs  are  administered.  Where  a  phy- 
sician engaged  In  a  general  practise  otherwise  admin- 
isters such  drugs,  It  will  be  necessary  for  him  to  keep 
a  record  of  the  date  when  any  such  drug  Is  dispensed 
or  administered,  the  kind  and  quantity,  and  the  name 
and  residence  of  the  patient. 

"Hospitals  and  sanatorlums  must  keep  a  record  of 
drugs  dispensed,  distributed,  or  administered  therein. 

"Government,  state,  county  and  municipal  officers, 
lawfully  engaged  in  purcliasing  drugs  specified  In  the 
act  for  the  army  and  navy,  the  public  health  ser- 
vice and  for  government,  state,  territorial,  district, 
county,  municipal  or  Insular  hospitals  or  prisons,  are 
held  to  be  exempt  from  the  provisions  of  the  act  re- 
lating to  registry  and  special  tax,  to  purchase  and  use 
of  such  drugs  and  to  the  keeping  of  records.  Any 
such  officers,  however,  engaged  In  private  practise 
must  register,  pay  special  tax  and  keep  the  records, 
and  comply  with  all  the  requirements  of  the  law  and 
regulations."] 

BELGIAN  PHYSICIANS'  RELIEF  FUND. 

Report  or  the  TREAsraEB  of  the  Committee  fob  the 
Week  Ending  March  20,  1915. 

CONTBlBUnONS. 

Sebastian  Co.  Medical  Soc.,  Fort  Smith,  Ark.  $  16.00 

Or.  F.  W.  Johnson,  Boston,  Mass 26.00 

Or.  E.  p.  Qualn.  Bismarck.  North  Dakota 10.00 

Dr.  N.  O.  Ramstad.  Bismarck,  North  Dakota.  10.00 

T)r.  Haven  Emerson,  New  York,  N.  Y 15.00 

Dr.  Edward  B.  Angell,  Rochester,  N.  Y 10.00 

Dr.  T.  A.  Davis,  Chicago,  ill 25.00 

New  Bedford  Med.  Soc..  New  Bedford,  Mass.  60.00 

Or.  Newton  B.  Waller,  New  York,  N.  Y 6.00 

Dr.  Charles  O.  Elcher,  McKees  Rocks,  Pa 6.00 

Dr.  William  H.  Perry,  Sterilng.  Ill 6.00 

Dr.  F.  A.  Spafford,  Flandroau,  S.  Dakota 10.00 

Dr.  George  L.  Johnson,  NowfoUlen,  Minn 1.00 

Salt  Lake  Co.  Med.  Soc.,  Salt  I-ake  City.  Utah  100.60 

Dr.  and  Mrs.  Clem  D.  McCoy,  Kenton,  Ohio. .  50.00 

Dr.  E.  A.  Wel.ss,  Pittsburg.  Pa 10.00 

Dr.  Hubert  Claytor,  Hopkins,  S.  C 5.00 

Dr.  C.  E.  Goodman,  Virginia,  Minn 5.00 

Trl-County   Medical    Society,    Copiah-LIncoln- 

Pike  Counties.  Miss 10.00 

Dr.  Harold  W.  Dana,  Boston,  Mass 26.00 

Receipts  for  the  week  ending  March  20 $  391.50 

Previously  reported  receipts 4830.00 

Total  receipts $5221.50 

Previously  reported  dLsbursements : 
1C25  standard  boxes  of  food  @  $2.20.  .$3575.00 
.542  standard  boxes  of  food  <(i  $2.30. .  1240.60 
Disbursements   for   the   week   ending 

Mar.  20: 
173  standard  boxes  of  food  @  $2.30. .     397.90 


Total  disbursements $.')219.60 

Balance   $2.06 

F.  F.  Simpson,  M.D.,  Treasurer, 
7048  Jenkins  Arcade  Bldg., 
Pittsburg,  Pa. 


502 


BOSTON   MEDICAL  AND    SURGICAL   JOURNAL 


[April  1,  1915 


In  an  address  delivered  recently  by  Mr.  Lindon  W. 
Bates,  vice-chairman  of  the  Commission  for  Relief  in 
Belgium,  he  said : 

"The  Commission  was  granted  by  the  German  Gov- 
ernment not  only  the  sole  right  to  transport  food  into 
Belgium  but  given  the  active  sympathy  and  aid  of  the 
German  military  authorities.  Despite  reports  to  the 
contrary,  not  one  pound  of  food  sent  in  has  been  ap- 
propriated. The  treasury  of  the  Commission  draws 
from  the  generous  heart  of  the  world.  Into  this 
treasury  has  been  put  also  all  that  the  enveloped  Bel- 
gian race  could  gather  of  the  remnants  of  their  shat- 
tered fortunes.  It  registers  their  struggle  for  sur- 
vival. It  represents  their  very  all —  the  all  that  the 
better-to-do  can  give  to  help  themselves  and  unre- 
servedly to  help  their  fellow  being  in  the  ranks  al- 
ready destitute  and  starving.  This  is  our  main  pur- 
chasing fund — the  greatest  and  the  sacredest  of  all 
the  donations." 

The  contributions  made  by  the  American  doctors, 
through  the  Committee  of  American  Physicians  for 
the  Aid  of  the  Belgian  Profession,  are  placed  in  the 
Sands  of  the  Commission,  for  distribution  among  the 
members  of  the  Belgian  Profession  and  their  families. 

Mr.  Brand  Whltlock,  American  Minister  at  Brussels, 
is  credited  with  saying  on  March  17,  that  the  food 
then  in  Belgium  would  not  last  longer  than  April  1. 


UNITED  STATES  CIVIL  SERVICE 
EXAMINATION. 

The  United  States  Civil  Service  Commission  an- 
nounces an  open  competitive  examination  for  mine 
surgeon,  for  men  only.  From  the  register  of  eligibles 
resulting  from  this  examination  certification  will  be 
made  to  fill  a  vacancy  in  this  position  in  the  Bureau 
of  Mines,  Pittsburg,  Pa.,  at  a  salary  ranging  from 
$2400  to  $2700  a  year,  and  vacancies  as  they  may  oc- 
cur in  positions  requiring  similar  qualifications,  un- 
less it  is  found  to  be  in  the  interest  of  the  service  to 
flu  any  vacancy  by  reinstatement,  transfer,  or  promo- 
tion. 

Graduation  from  a  medical  school  of  recognized 
standing,  and  at  least  two  years'  medical  and  surgical 
experience  with  industrial  workers,  are  prerequisites 
for  consideration  for  this  position.  Statements  as  to 
education  and  experience  are  accepted  subject  to  veri- 
fication. Applicants  must  not  have  reached  their 
forty-fifth  birthday  on  the  date  of  the  examination. 
This  examination  is  open  to  all  men  who  are  citizens 
of  the  United  States  and  who  meet  the  requirements. 
Persons  who  meet  the  requirements  and  desire  this 
examination  should  at  once  apply  for  Forms  304  and 
2095,  stating  the  title  of  the  examination  for  which 
the  forms  are  desired,  to  the  United  States  Civil  Ser- 
vice Commission,  Washington,  D.  C. ;  the  Secretary 
of  the  United  States  Civil  Service  Board,  Post  Office, 
Boston,  Mass. ;  Philadelphia,  Pa. ;  Atlanta,  Ga. ;  Cin- 
clnnaU,  Ohio;  Chicago,  111.;  St.  Paul,  Minn.;  Seattle, 
Wash. ;  San  Francisco,  Cal. ;  Customhouse,  New  York, 
N.  Y. ;  New  Orleans,  La. ;  Honolulu,  Hawaii ;  Old  Cus- 
tomhouse, St.  Louis,  Mo. ;  or  to  the  Chairman  of  the 
Porto  Rican  Civil  Service  Commission,  San  Juan,  P.  R. 
No  application  will  be  accepted  unless  properly  exe- 
cuted, excluding  the  medical  certificate,  and  filed  with 
the  Commission  at  Washington,  with  the  material  re- 
quired, prior  to  the  hour  of  closing  business  on  April 
20,  1915. 


These  lectures  are  given  annually  under  the  terms 
of  a  bequest  from  John  Clarence  Cutter,  whose  will 
provided  that  the  lectures  so  given  should  be  styled 
the  Cutter  Lectures  on  Preventive  Medicine,  and  that 
they  should  be  delivered  in  Boston,  and  be  free  to  the 
medical  profession  and  the  press. 

The  members  of  all  classes  in  the  Medical  School, 
the  medical  profession,  the  press,  and  others  inter- 
ested, are  cordially  Invited  to  attend. 

Boston  City  Hospital  Alumni  Association. 

The  annual  meeting  will  be  held  at  the  Copley-Plaza 
on  Wednesday  evening,  April  7,  at  6.30  o'clock. 

Dinner  will  be  served  at  seven  o'clock  immediately 
after  the  business  meeting.  Dr.  L.  F.  Woodward  will 
preside. 

A  luncheon  will  be  served  In  the  hospital  library 
at  one  o'clock  to  which  members  are  Invited  by  the 
Trustees. 

WlLOAM   H.    ROBEY,   JB.,   M.D., 

220  Commonwealth  Avenue.  Secretary. 

Massachusetts  General  Hospital. 
A  medical  meeting,  open  to  the  medical  profession, 
will  be  held  at  12  noon  on  Monday,  April  5,  1915,  In 
the  lower  amphitheatre  of  the  Out-Patient  Depart- 
ment.   Entrance  on  Fruit  Street. 

1.  Exhibition  of  Cases. 

2.  Dr.  Roger  I.  Lee.    "Splenectomy    in  Pernlcioua 
Anemia." 

3.  Dt.  Oswald  H.  Robertson.    "Urobilin  Estimation 
In  the  Stools.    Its  Relation  to  Hemolysis." 

4.  Dr.  Paul  D.  White.     "Alternation  of  the  Pulse. 
A  Common  Clinical  Condition." 

F.  A.  Washbubn,  M.D., 
Resident  Physician. 


SOCIETY  NOTICE. 
The  Society  of  American  Bacteriologists. — The 
Council  of  the  Society  of  American  Bacteriologists 
has  decided  to  hold  a  special  summer  meeting  in  San 
Francisco,  August  3,  4,  and  5,  1915.  The  chairman 
of  the  local  committee  of  arrangements  is  Dr.  Wil- 
fred H.  Manwaring,  Stanford  University,  California. 


NOTICES. 
The  Cutter  Lectuee. 

The  Cutter  Lecture  on  Preventive  Medicine  and 
Hygiene  will  be  given  by  Joseph  Goldberger,  M.D., 
Surgeon,  United  States  Public  Health  Service,  Wash- 
ington, D.  C,  on  the  subject  of  "Diet  and  Pellagra," 
on  Friday,  April  2,  at  the  Harvard  Medical  School, 
5  to  6  P.M. 


APPOINTMENT. 
Dr.  Philip  J.  Castleman  has  been  appointed  director 
of  the  bacteriologic  laboratory  of  the  Boston  Board 
of  Health,   in   succession   to   the   late   Dr.    James   J. 
Scaflnell. 

-• -^ '■ 

RECENT  DEATHS. 

Db.  Michael  C.  Drennan,  who  died  on  March  23, 
at  Easton,  Pa.,  was  born  in  1839.  He  served  as  a 
naval  surgeon  throughout  the  civil  war  and  was  re- 
tired In  1899  with  the  rank  of  rear-admiral. 

Db.  Daniel  J.  O'Shea,  who  died  of  pneumonia  on 
March  23  at  East  Boston,  was  born  there  In  1876. 
He  was  a  graduate  of  Boston  College  and  studied  at 
the  Harvard  Medical  School.  He  is  survived  by  his 
widow,  two  daughters  and  one  son. 

Db  Amos  Patebson  Webber,  for  32  years  a  practi- 
Uoner  of  New  Bedford,  Mass.,  died  In  that  city  March 
20  aged  55  years.  He  was  a  graduate  of  Bellevue 
Hospital  Medical  College  in  1883  and  was  a  member 
of  the  staff  of  St.  Luke's  Hospital.  He  was  a  Fellow 
of  The  Massachusetts  Medical  Society  and  of  the 
American  Medical  Association,  and  was  prominent  In 
Masonic  circles.    He  is  survived  by  his  widow. 


BOOKS  AND  PAMPHLETS  RECEIVED. 
Discussion  on  the  Milk  Supply  as  a  Causal  Factor 
in    Relation   to   Tuberculosis,   by    Sheridan   Deleplne, 
M.D.,  M.Se.     Reprint. 


Vol.  CLXXII,  No.  13] 


BOSTON   MEDICAL  AND   SURGICAL  JOURNAL 


XUI 


Gives  Rapid  and  Reliable  Results 

in  Circulatory  Disturbances 


FOR  ORAL  USE 
Tablet*,  1  '4  grn.  in  tubes  of  12  lableti. 
Powder  in  Js-oz.  vials. 
Solution  for  oral  use  in  10  Cc.  vials. 


FOR  INJECTION 
Ampule*  of  1  Cc.   each   for 
intravenous,  intramuscular 
and    (ubcutaneous    uie. 


Eacli  Tablet  or  I'z  grn.   Powder  or  1  Cc.   Solution 
or   1  Ampule  equals  8  frog  uniis. 


Samples  und  hull  Literature  from 

KNOLI.  (SL   CO. 

45  JOHN  ST^  NEW  YORK 

For  Sale  by 

MERCK    ax    CO. 

NEW  YORK  and  ST.  LOUIS 


yvCciAo^ 


Agar   (Granular),    P.   D.  &    Co. 

FOR  TREATMENT  OF  CHRONIC  CONSTIPATION. 

Agar  is  a  product  of  Japan,  derived  from  seaweed  and  sometimes  known  as  Japanese 
gelatin.     It  is  supplied  commercially  in  dry,  transpjirent  pieces  that  are  reduced  to  coarse 
flakes  for  medicinal  use.     It  freely  absorbs  water  and  retains  it     It  resists  the  action  of 
the  intestinal  bacteria  and  of  the  digestive  enzymes.     Its  chief  use  in 
medicine  is  in  the  treatment  of  chronic  constipation. 

Agar  may  be  eaten  with  milk  or  cream,  or  with  a  cereal  breakfeist 
food,  salted  or  sweetened  to  suit  the  taste. 

Agar  is  not  digested.  It  passes  practically  unaltered  into  the 
intestine,  where  it  moistens  the  feces.  It  serves  as  a  mechanical  stimu- 
lant to  the  bowels,  aiding  in  the  production  of  a  normctl,  hetJthy 
evacuation— a  condition  approximating  the  natural  function. 

Pound  and  9^ -pound  packages. 
WRITE  FOR  DESCRIPTIVE  CIRCULAR. 


Detroit,  Michigan. 


Parke,  Davis  &  Co. 


XIV 


BOSTON   MEDICAL  AND   SURGICAL  JOURNAL 


[APBn,  1,  1915 


The  Home  of 
Clothes-Style  and  Service 


Men's,    Young     Men's    and    Boys' 

Suits  and  Overcoats 

to  fit  every  phase  of  life — business,  professional  and  social. 
Made  on  the  premises — presenting  a  comprehensive  number  of 
models  to  satisfy  every  preference. 


HATS  — Stetson's  Exclusively. 


Furnishings. 


Macullar  Parker  Company 


400  Washington  Street 


Boston 


Vol.  OLXXII,  Xo.  13] 


BOSTON   MEDICAL  AND  SURGICAL  JOURNAL 


XV 


nDet)ical  Schools  ant)  Ijospitals 


HARVARD   MEDICAL  SCHOOL 

Exceptional  laboratory  facilities  for  teaching  and  research.  Abundant  opportunities  for  clinical 
instruction  in  closely  allied  hospitals,  a  number  of  whidi  are  grouped  about  the  buildings  of  the  Medical 
School.     Courses  for  the  Degree  of  Doctor  of  Public  Health. 

GRADUATE  SCHOOL  OF  MEDICINE 


ADMISSION  REQUIREMENTS:  Either  (1)  a 
degree  in  arts  or  science  from  a  recognized  college 
or  scientific  school,  or  (2)  two  years'  work  at  a  col- 
lege or  scientific  school  of  high  rank  with  evidence 
that  the  candidate  has  stood  in  the  first  third  of  his 
class;  with,  in  each  case,  such  knowledge  of  physics, 
biology,  general  chemistry  and  organic  chemistry 
as  may  be  obtained  from  year's  courses  of  college 
grade,  and  a  reading  knowledge  of  French  or  Ger- 
man.    Applications  requested  before  July  1st. 


Graduate  Instruction  on  a  University  Basis 
COURSES   are    given    throughout    the    year    in    all 
clinical  and  laboratory  subjects. 

INSTRUCTION  will  be  as  thorough  and  scientific 
as  in  the  Medical  School  proper.  Elementary  and 
advanced  courses.  Research  courses  for  qualified 
students. 

STUDENTS  are  admitted  at  any  time  and  for  any 
length  of  study. 
For  information  address 
HARVARD  MEDICAL  SCHOOL,  Boston.  Mass. 


NEW  YORK  POLYCLINIC   MEDICAL  SCHOOL  AND   HOSPITAL 


The  Tirsl  Post-Graduate 
Medical  School  in  America 


Chartered  by  the  University 
of  the  State  of  New  York 


345  to  349  West  SOth  Street,  New  York  Oty 

Most  modern  school  and  hospital  building:,  cunsistin):  of  3  amphitheatres,  6  Internal 
medicine.  6  operating,  23  specialty,  and  8  Ubontoir  rooms. 

Hospital  accommodation.  800  beds;  ont-door  serrlce,  100.000  Tlalts  annnally;  am4 
an  active  emergency  and  ambulance  tervioe.  In  a  district  containing  360,000  people. 

General  and  advanced  courses  in  all  branches  of  medicine,  surgery  and  the  special- 
ties, under  eminent  teachers,  and  in  completely  equipped  departments,  and  at  Um 
bedside. 

Diagnosis  and  treatment  thoroughly  taught,  and  the  courses  are  arranged  to  allow 
of  matriculation  at  any  time.     For  further  liiformatlon,  addr 

Pretiident  of  the  Faculty. 
JOHN  A.  WTETH,  MJ),  LLJ), 


or  MB.  JOHN  GUNN, 
Superintendent 


TUFTS  COLLEGE  MEDICAL  SCHOOL,  Boston,  Mass. 

This  school  offers  a  four-year  course  leading  to  the  degree  of  Doctor  of 
Medicine,  the  school  beginning  each  year  on  the  last  Wednesday  in  September, 
and  ending  the  second  Wednesday  in  June. 

Students  of  both  sexes  are  admitted  upon  presentation  of  an  approved  high 
school  certificate  and  in  addition  college  credit  indicating  one  year's  work  in 
Chemistry,  Physics,  Biology  and  French  or  German. 

Well-equipped  laboratories  and  abundant  clinical  facilities  furnish  oppor- 
tunity for  a  thoroughly  practical  course  in  medicine. 

Address  all  communications  to 

'FRANK  E.  HASKINS,  M.D.  Secretary, 

416  Huntington  Avenue,  Boston,  Mass. 


BOSTON  LABORATORIES 

30  Huntington  Avenue 

Copley  Square,  Boston 

For  Bacteriological,  Bio-chemical  and  Patho- 
T  logical  Diagnosis 

Wattermann,  $5,   Schwartz-McNeil,  $5. 

Quarters  forinerly  occupied  by  the 

Boston  Board  of  Health  Laboratory 

Telephone.  Back  Bay  5156 


HARVARD  DENTAL  SCHOOL  |SYRACUSE     UNIVERSITY 

BOSTON,  MASS. 

k  department  ol 

HARVARD  UNIVERSITY 


Forty-seventh  year  began   Sept.  28, 
1914.    Send  for  announcement 

Dr  Eugene  H.  Smith.  Dean. 


Collese  of  Medicine 

Ektbaiici  RiQcniuiicTi:    Two  jean  in  a  1 

Oollece  or  School  o(  Bdence  which  mint  ia- 
elude  Latin.  Oerman,  PhTiics,  Chemiatrj  and 
Biology.     Combination  courses  recognized. 

LaIobatost  Ciointsss  in  well-equipped  laboratorio 
under  full  time  teachers. 

Olixical  Conasis  in  two  general,  one  special  an< 
the  municipal  hospitals  and  in  the  new  coUegi 
dispensary  now  building,  in  all  of  which  senioi 
students  serve  as  clinical  clerks. 


kMn 


THI   SBOUTABT  or  THB  COLI.MB  OF  JIniei>B 

SOT  Orang*  St.  BTraeuse,  R.  T. 


XVI 


BOSTON   MEDICAL  AND   SURGICAL  JOURNAL 


[APRn,  1,  1915 


professional  darbs 


The  Ring  Sanatorium 
and  Ariington  Health  Resort 


professional  Car^s 


FOR  CHRONIC,  NERVOUS  AND 

MILD  MENTAL  ILLNESSES 

8  miles  from  Boston 

_  ,     ,  A   1-      »        oi       (  Sanatorium 

Telephone.  Arlington  81      j      Resort 

ARTHUR  H.  RING,  M.D. 
Arlington  Heights,  Mass. 

Dr.  Melius'  Private  HospltaJ 
For  Mental  Diseases 


NEWTON,  MASS. 


Announcement 

Dr.   Melius   has   removed  his   Hospital 
from    West    Newton    to    419    Waverley 
Ave.,  Newton,  Mass. 
Extensive  grounds,  fine  shade  trees,  five 
minutes'  walk  from  electrics. 
Beached  by 

Train  to  Newton,  or  by  electric  can  Tla  OonmiOD- 
wealth  Avenue,  to  Grant  Avenue. 


WOODSIDE  COTTAGES 

FRAMINGHAM,  MASSACHUSETTS 

(Ofl  ladlaa  Head  Hill) 

A  private  establishment  for  the  care  and 
treatment  of  chronic  diseases,  including 
fatigue  neuroses  and  neurasthenia.  No 
insane  or  other  objectionable  cases  re- 
ceived. Three  houses  with  all  modem 
appointments;  opportunity  for  tenting 
in  pine  grove;  beautiful  country  location. 
Illustrated  prospectus. 


Devereux  Mansion 

Marblehkad,  Massachusetts. 

A  sanitarium  without  the 
usual  conditions  of  invalid- 
ism. 

Work  and  rest  under  favor- 
able conditions  form  the  back- 
ground of  all  medical  treat- 
ment. 

Herbert  J.  Hall,  M.D. 

Medical  Director 


WELLESLEY  NERVINE 

A  Sanitarium  for  Uie  Treatment  of 
Nervous  and  Mild  Mentai  Diseases 


New  Buildings,  every  facility  for  com- 
fort; in  the  midst  of  twelve  acres  of  high 
land,  covered  with  beautiful  oak  and  pine 
trees,  fully  equipped  tor  hydro-thera- 
peutic and  electrical  treatment. 
Address 

EDWARD  H.  WISWAIL,  MJ). 
IVellesIey,  Mass. 

Telephone  Wellesley  261 


professional  Car^s 


Twilight  Sleep 
Maternity  Hospital 

197  Bay  State  Road 

Physicians  wishing  to  use 
the  Dammerschlaf  method 
in  their  obstetric  cases  are 
invited  to  use  the  above- 
named  hospital.  Graduate 
obstetrical  nurses  only  in 
attendance,  under  the  di- 
rect supervision  of 

E.  T.  Ransom,  M.D. 

Telephone,  Back  Bay  1716 


TOWER  HALL      > 

DERRY,  N.  H. 

Forty  miles  from  Boston. 

Is  admirably  adapted  both  bjr  location  and  equip- 
ment for  the  care  of  nervous  and  chronic  diseases. 
Several  eminent  Boston  specialists  are  on  the  staff 
of  consultants. 

F.  A.   TOWER,  M.D. 


CC 


BELLEVUE 


99 


Superior  home-like  accommodationfl  for  five  pa- 
tients. Nervous  and  mild  mental  disease,  selected 
cases  of  alcoholism,  and  elderly  persons^  for  whom 
medical    supervision    is    desired,    are    received. 

MARY  W.  L.  JOHNSON,  M.D. 

46  WoLCOTT  Road,  Chbstndt   Hill,   Hiss. 
Telephone,  Brookline  6S81-W. 


HERBERT  HALL  HOSPITAL,  Inc. 

WORCESTER,    MASS.     EstabHshed  in  1872. 


A  Hospital  for  the  Care  and  Treatment  of  those 
afflicted  with  the  various  forms  of  Nervous  and 
Uental  Disease. 

For  information  address 
JOHN  MERRICK   BEMIS,   M.D. 
WALTER   C.    HAVILAND,    M.D. 


nHANNING    SANITARIUM  for 
^  MENTAL    DISEASES 

EsUblished  1879. 

Brookline,   Mass.  Cor.  Boylston  Street 

and  Chestnut  Hill  Avenue. 

WALTER  CHANNINO,  M.D. 


NEWTON  SANATORIUM 

For  invalids  with  nervous  and 
mild  mental  diseases, 

DR.  N.  EMMONS  PAINE 

West  Newton  :-:  Massachusetts 


QLENSIDE 

For  Nervous  and  Mental  Diseases 

6  Parley  Vale, 

Jamaica  Plain,  /lass. 

MABEL  D.  GROW  AY,  H.  D. 

Telephone,  Jamaica  44. 


BOURNEWOOD    HOSPITAL 

FOR 

MENTAL  DISEASES 

Establtehed  1884 

BROOKLINE,  MASS.        SOUTH  ST. 

Nesr-rt  sUtion  BeUevue,  N.  Y.,  N.  H.  Ji  H.  K.  K. 
HiifBT  R.   Stbdiux,  M.D.       Oio.  H.  Torhit,  M.D. 

or.  Albert  E.  Brownrigg 

receives  Nervous  Invalids  who  require  a  spedftUrt*! 
constant  supervision  and  intelligent  mining  car* 
at  his 

Highland  Spring  Sanatorium 

a  homelike  resort  amon?  the  pines  of  New  Hamp- 
shire, one  hour's  ride  from  Boston.  Number  limited 
to  fifteen.  Trains  in  six  directions  throughout  New 
England.     Telephone  or  address  him  at 

Nashua,  N.H. 


Vol.  CLXXII,  No.  13] 


BOSTON   MEDICAL  AND  8VRG1CAL  JOURNAL 


xvu 


professional  Cart>0 


MILLET  TUBERCULOSIS  SANATORIUM 

EAST    BRIDCEWATER,  MASS. 

Patienta  are  under  coueUnt  ob«ervation  daj  and  night.  The  MedieftI 
Director  makea  •  tbotongli  wtadj  ot  each  o*ae,  thus  adjuating  treatment  to 
variations  in  conditioiB.  Bmy  ajmptom  la  noted  and  traced  to  ita  cauee, 
ao  that  a  regimen  baaed  on  the  peraonal  idioaTncraaiea  of  the  patient  ia  accur- 
ately developed.  lacfa  day  anry  patient  apeoda  at  leaat  twenty  houra  out  0< 
doors.  This  method,  aaaiKad  by  a  tempting,  wholeaome,  and  abundant  table, 
gives  the  patient  a  good  appetite,  aolying  the  important  question  of  oouriab- 
meot. 

The   sun   hatha   are   particularly   beneBclal    to    tboae   who   are   anemic   or 


The  lliUet  Samtorium  i*  near  East  Bridgewater  aUtion  on  N.  T.,  N.  H. 
*  H.  R.  R.  Twanty-Sva  milea  southerly  from  Boston.  From  Brockton  or 
Bridgewater  the  laaatorium  is  eaaily  reached  by  trolley. 

For  further  informatian  call  upon  Dr.  Millet  at  hia  Boston  olBca,  til 
Boylaton  Street,  oa  Tuaadaya  and  Fridaya.     Telephone,  Back  Bay  4100. 

Or  addraaa 

CHARLES  S.  MILLET,  M.D..  East  Bridgewater,  Mass. 


THC    FISK    HOSPITAL 

FOR  THFl  TREATMENT  OP 

ALCOHOLISM  AND  DRUG  ADDICTION 

(BY  THE  TOWNS-LAMBERT  METHOD) 
raiVATa  booms — ooHririiiT  fhtbiouiiii — tsaixid  xntan 
1    RICHARD  O.  OABOT,  IIJ>„  Bastaa,  Ummm 

p„yL,r,!„a         WILLIAM  OTIi  FAXON.  MJJ,  atMSkt.a.  Ummm. 
PBYBIClANa         UDONARO   HVimuaS,  MJ)..   Lowell,   Mawa. 
RUFCa  W.  SFRASira.  1I.D„  Baatea.  Ilaaa. 

Dr.   Ricrakd  C.   Cabot  says:     "tThe  treatment  has  great  value,  etpeciatlv 
in  the  cure  of  the  morphine  habit." 

THIS  METHOD  OF  TREATMENT  bM  been  published  In  detail  In  The 
Journal  of  the  American  iledical  Atiooiation,  and  U  endorsed  by  publica- 
tion In  Osier  and  McCrae's  Modem  Medicine,  VoL  11,  1914. 
bis  method  of  treatment,  and  the  results  obtained  have  been  moHt  satisfactory. 

on*  BrooKllBa  S630                   106  SEW  ALL  AVE.,  BROOKLINE,  MASS 

I 
c 

"mam  -^^ 

JlS''^' 

""or  five  years  we  have  used  exclusively  t 

:harles  d.  b.  fisk.  Supt.             rh 

GLENELLIS  SANITARIUM 

(Established  1906) 


The  looation  In  the  Tvooded  hlshlanda  of 
the  Raniceley  Lake  reKlon  la  eapeclallr 
beneflelal  to  a  larse  number  ot  Bon-aiir> 
slcal  eondltlona. 

Special  Attention  la  Given  to  Caaea  at 
FUNCTIONAL   NERVOUS  TROUBLB 
CONVALBSCEINTS    AND   OTHERS 

NEEDING   REST  AND    «UIBT 


Addreaa 


fRANK  I  ilM,  M.D. 

ANDOVER.      OXFORD   COUNTY,     HAINB 


Medical  School  of  Maine 

BOWDOIN  COLLEGE 

Addison  S.  Thateb,  Dean 
10  Deerlng  Street       -       -    Portland,  Me. 


Tl^e  Westpori 
Sanitarium 


■■TAILUIIBI) 
1980 

'Wvatport 
Conn. 

Licensed  by  the  stata  ot  Connecticut  (or  the  care 
and  treatment  ot 

Ntroous  and  Mental  Diseases 

Modem  appointmenta.  home  life,  beautiful  sorrouad- 
Ingi,  large  prirate  grounds.  Committed  and  Toluo- 
tary  patienti  received.  Terma  moderate.  Inapection 
of  metboda  and  equipment  invited.  For  further  !■• 
formation  and  terma,  addreaa 

Dr.  P.  D.  RULAND,  WeBtport.  Coaa. 

TWephone,   4. 

NEW  YORK  OFFICE,     40EMt4lrtSt 

Telephone,    OSSO    Murray   Hill 
First  and  Third  Wedneadaya,  10.10  A.M.  to  ILIO  T.u. 


West  Newton  Home  School 

FOR 

Backward  or   Nervous  Youiut  CIrts 

Toaaf  firla  reccired  who  are  ncrrous  or  back- 
ward or  who  for  any  reaaon  require  speoiai  oare  aa4 
tMrhinc. 

Home    itfe    in    a    pleaaaot    country    house,    aunay 
TO^a,  Tsranda,  pine  traaa,   larye  prlrata  grtwinda. 
j  MISS  KATHASINK  BABTIOAM,  B.N., 

147  WaLTHAif  It.,  Waar  Niwtox,  Maai, 
Telephone,  Newton  Waat  t4t-W. 


MISS  MOULTON 

80  Hammond  St.,  Chestnut  Hill,  Mass. 

Special  children  in  home-school.  Lim- 
ited. Waiting  list.  Associated  many 
years  as  Principal  with  Dr.  W.  E. 
Femald,  Waverley,  Mass. 

Tel.,  Newton  South  327  | 


Where  and   Why? 

Dr.  Oivcns'  Sanitarium  at  Stamford,  Cono. 

(60  Minutea  from  New  Tork  City) 
Offers  exceptional  opportunitiea  for  the  treatment  ot 

NERVOUS    and    MILD    MENTAL    Dlgeases 

and  has  separate  detached  cottagea  (or  persona  who 
deaire  perfect  priracy  and  plcnaant  surroundings, 
and  who  are  addicted  to  the  uae  a<  STIMULANTS 
or  DRUGS. 

The    sanitarium    ia    on    a    hill    overlooking    Long 
Island  Sound.     Write  or  wire. 

Dr.  Givens'  Sanitarium 
SLamford,  Conn. 


XVlll 


BOSTON   MEDICAL  AND   SURGICAL  JOURNAL 


[Apkh,  1,  1915 


NOTICES  ON  THIS  PAGE  ARE  PRINTED  FOR  THE  JOURNAL  SUBSCRIBERS  WITHOUT  CHARGE 


THE  ATTENTION 


PRACTICE  FOR  SALE 

$4000  grrowing  practice  in  a  town  20  milee  from  Boston.     Population  S500 
Of  Doctors    and  all   others   who  drive  FORD   AUTOMOBILES       ■"   "'"'^y-   lO'O^O  i"  sunimer.     Specialty    the   reason    for   selling.      Tennfl    to 

Is  called  to  the 


BOSTON  STARTER 


suit  pureiiaser. 

Dr.  C,  Boston  Medical  and  Suroical  Journal. 


RESIDENT  PHYSICIAN  WANTED 


Its  advantages  are  incomparable,   especially   for   physicians. 
It  gives  you  absolute  control  of  your  car  from  the  seat.        ;       ,.  .u    r,.,  o    •»  *„»,,,■  »    ,,• 

!         At  the  Channing  Sanitarium  for  Mental  Diseases,  Brookline,  Mass.,  an  aa- 

Write  for  testimonials.  i  sistant  resident  phjsician  to  start  service  July  1,  1915.     Applicant  should  be 

^~^^~~~~  young  and  unmarried.     Address,  giving  qualifications  and  references. 
AlltOniStiC    Appli8nC6    Co*  Donald  Gregs,  M.D.,  brookline,  Mass. 

172  Columbus  Ave.  Phone  5412  Oxford  Boston 

I 

WANTED  -  RESIDENT  BACTERIOLOGIST 

I  Inquiries  should  be  made  of  Dr.  Elliott  Washburn,  Superintendent,  Rutland 
'  State  Sanatorium,  Rutland,  Mass.,  or  of  Dr.  John  B.  Hawes,  2d,  Secretary,  3  Joy 
,    Street,   Boston,   Mass. 


PRACTICES    -    LOCATIONS    -    POSITIONS 

We  offer  exceptional  opportunities  to  the  profession.  If  you 
wish  to  dispose  of  your  practice,  secure  an  assistantshlp,  loca- 
tion, salaried  ixmitlon  or  purchase  a  practice,  write  for  our 
plan,  stating  In  which  you  are  interested. 

The  Medical  Echo,  Lynn,  Mas*. 


AMERICAN  ENGRAVING  CO. 

MAKERS  OF   FINK     HALF-TONE 

LINE  ENGRAVING 

AND  COLOR   WORK 

94    Arch    St.   and   13   Otis    St..    BOSTON.   MASS. 

Orders  for  Medical  Drawings  Solicited 

FRANK    HENDRY,    MANASIR                                      TaLIPMONI.  FOHT   HILU  879 

DOES  YOUR  ELECTRICAL  APPARATUS  need  REPAIRING? 

5end  it  to 

ROBERT  C.  GODFREY 

687  Boylston  Street,     (cor.  Exeter  Street)     Boston,  Mass. 

Telephone,  Back  Bay  21980 

Everything  from  the  smallest  to  the  largest  instrument  repaired 


WARREN    CHAMBERS 

THE  OFFICE  BUILDING  FOR  DOCTORS 
419  Boylston  Street,  Boston 

TO  LET : — A  small  suite  consisting  of  two  offices 
and  reception  room.  Also  one  of  one 
office  with  reception  room. 

For  further  particulars  apply  to 

W.  E.  WENTWORTH,  Supkrintendekt. 
Tel.  B.  B.  4200. 


.  CLXXir,  No.  13] 


BOSTON   MEDICAL  AND   8CRGICAL  JOVRyAL 


XIX 


Prescribe  with  confidence 

Welch's  Grape  Juice  is  suggested  whenever  you 
require  a  *'pure  fruit  juice." 

Its  pleasing  tart-sweet  flavor,  purity  and  full- 
bodied  quality  will  be  welcomed  by  the  patient. 
To  the  convalescent  it  will  smack  of  recovery — 
will  recall  memories  of  the  happy  days  of  health, 
and  promise  cheer  for  the  days  to  come. 

Welch's 

Grape  Juice 

It  is  absolutely  pure.     The  reputation  of  Welch's,   in  this 

respect,  affords  you  ample  assurance. 

May    we   also   suggest   that   you   become    acquainted    with 

Welch's  in  your  own  family  circle.'     It  is  a  delicious  health 

beverage — one  to  enjoy  all  year  'round. 

Welch's  is  supplied  in  convenient  4-oz. ,  half-pint,  pint  and 

quart  bottles. 

Si>ccial  literature  of  intemt  to  phyticians  mailed  on  requett. 

The  Welch  Grape  Juice  ComfMuiy,  Westf ield,  New  York 


»-^ 


►'■A 


*v  -« 


>4EW  YORKl  university         medical  defartment 

THe   University-  and   Dellevue  Hospital  Medical  Coll«^«.  Session  191iS-16 

The  MMion  besiu  on  Wcdoadar,  September  22,  101S,  and  cuntlnua  (or  eicbt  month*. 

Attendance  upon  (our  eounee  o(  lecture*  it  required  (or  cnduatloD. 

The  entrance  requirement!  are  aa  (ollom:  (1)  The  Medical  Student  CertiScate  iaaued  bjr  the  Mew  Tork  Stat*  Education  Dapartaant  upon  the  coopl*- 
tion  o(  a  (our-ycar  hifli  acfaool  rourae.  (t)  One  year'a  work  o(  college  atandard.  which  year  must  include  intnictlon  in  Cbemiatrjr,  Phyiic*,  Blologr,  and 
German  or  French.     Thia  year  muKt  be  in  addition  to  the  high  w  h"ol  rounip. 

Student*  who  have  attended  one  or  more  regular  couiiaa  at  other  ■ccretliti'd  Medical  OoUcce*  are  admitted  to  advanced  rtandinc  (except  In  the  Senior 
year)  on  presentation  of  credentials  meetinK  the  requirenirnts  o(  the  riaa*  in  which  they  aeek  aifiniaaion,  and  upon  examination*  on  the  subjecta  embraced  in 
the  curriculum  of  this  coUe^i-. 

ror  the  annual  circular  givii«  full  detail*,  addreaa  DR.  8AMUF.I.  A.  BROWN.    i'iee-Owm,  Sacratery,   tsth  Street  and    Firat  Avenue,   New   York  City. 


THE  NEW  YORK  EYE  AND  EAR  INFIRMARY 
School  of  Ophthalmolonr  iind  Otology 

For  Gnulaatoa  of  M*<tic<n« 

OUnloi  daily  by  the  Surgical  Staff  o(  the  Infirmary.     Special   coursea  in  Ophthalmoeeopy, 
Uoa,  Operative  Surgery  of  the  Eye  and  Ear,  Pathology  and  External  Diaeaae*  of  the  Eye. 

The  abundant  clinical  material  o(  thi*  well-known  institution  afford*  atudenta  an  unusual  oppor- 
tanity  (or  obtaining  a  practical  knowledge  of  theae  special  subjects.  Two  vacancies  in  the  House  8taS 
axi*t  in  March,  July,  and  November  o(  each  year.     For  particulars  address  the  Secretary. 

DR.  OBOROE  S.  DIZON,  Kiw  Voaa   En  ikd  Eai  IirouiaaT. 


Who  Wants  Journals? 

We  offer  the  last  complete  set  in 

stock  of  the    Boston    Medical    and 

SUBOICAL    JoiraNAL    for    1910-1911- 

1912.     Vols.  162-163-164-165-166-167. 

$2.50  each. 

Boston  Medical  and  Surgical 

Journal.       ■       Boston.  Mass. 

N'uraea'    Directory viii 

Parke,  Davia  k  Co. '....:*. xiii 

Phillipa'  Chemical  Co. xii 

Pomeroy vl 

Profeaalonal  Cards xvl  apd  xvii 

Quaker  Oats xi 

.launders,  W.   B.  Co Publishers  i 

Sthering  &  Glau Medinal  ill 

Sharp  ft  Dohme -...-..,,....,  .Chemists  v 

Hhemian's   Bacterin* 1. iv 

Syracuse  University , xv 

Tu(t8  College  Medical  School jcv 

Warren  Chambers '....•« xvlii 

Welch's  Grape  Juice ...,....,» xix 


INDEX  TO  ADVERTISEMENTS 

Ai?ur  Alfar Mansfleld  I.aI)oratoric^       vii 

rican  Engraving  Co xviii 

niatic  Appliance  Co xviii 


-■r*8  FoocI 

ii-n's  Condensed  Milk... 
•i\  Hygienic  Corset  Co., 
>n    liiboratorifs 


lie  Service  Tire  and  Rubber  Co 

hild   BroR.  ft  Fo«ter 

ft  Arnold Artiflcial  Limbs 

-mh  Lick  Springs Pinto  Water 


XX 


Godfrey,  Robert  C x\M\ 


Harvard  Dental  School x^' 

Har%-ard  Medical  School xv 

Hotel    Cumberland ^  jii 

FnterimtioiuU    liiKtriiment   (*o xi 

King's   Puremalt v 

Knoll  k  Co Dlgipuratum  xiii 

Macullar  Parker  Co Clothing  xiv 

Mahadv .    E.    F.   Co ii 

Massachiisettf^  (>eneral    Hospital ix,  xii 

Medical  S(  hoiil  of  Maine xvii 

MelUn'p    Food ,^ xii 

Miller   Rubber  Co ix 

New  York  Eye  and  Ear  Infirmary xix 

\ew  York  Polyclinic  Medical   School xv 

New  York  I'niversity,  . .  .*, xix 


XX 


BOSTON   MEDICAL  AND   SURGICAL  JOURNAL 


[Apbu,  1,  19. 


Prescribed  by  the 
Medical  Profession 
for  35  years. 


A   CEREAL   FOOT> 

different  from  all  others 


Mr.Benger*s  I 

admirable  i 
preparation." 

The  LANCET.  t 


because     it     contains     the     natural 
digestives — Trypsin  and  Amylopsin, 

It  is  used  regularly  in  Hospitals,  Sanatoria,  Nursing  Institutions,  etc., 
throughout  the  world,  and  prescribed  and  recommended  by  leading 
physicians  in  practice  and  in  many  standard  medical  works. 

The  outstanding  features  of  Banger's  Food  is  its  power  of  self-digestion,  and  milk  modification, 
due  to  the  two  digestive  principles  contained  in  it.  This  occurs  during  its  preparation  with  fresh  new 
milk  and  is  simply  regulated  by  allowing  the  Food  to  stand  from  5  to  45  minutes  ;  it  is  stopped  by  boiling. 


Ret:.  US.  Pat.  O^. 


For  Infants,  Invalids  and  the  Aged. 

A  physiaan's  sample,  7Vtth  full  particulars^  will  be  sent  Post  free  to  any  memhe*-  of  tht  medical  profession  on  apjji^ation  t 

BENGER'S  FOOD   LTD.,  92,  William  Street,  NEW  YORK. 

Manufactory MANCHESTER,  Eng. 

Branch  Office SYDNEY    (N.S.W.),    117,    Pitt    Street. Depots  throughout  Canada. 


Food 


The  Best  Prophylactic  Plan  to  correct  Infsuitile  Intestinal  In- 
fections is  to  find  a  Milk  Supply  which  has  proven  its  relia- 
bility, and  stick  to  it.   In 


Condensed 

JMILK 


THE  ORIGINAL 

you  have  a  Food  for  Infant  Feeding  which  meets  every  requirement ; 
being  Clean,  Safe,  Wholesome,  Palatable  and  Constantly  Uniform  in 
Composition. 

Write'todoY  for  Samples,  Analysis,  Feeding  Charts  in  any  language,  also  our 
5 o -page  book,  "Baby's  Welfare." 

BORDEN'S  CONDENSED  MILK  CO. 

"  Leaders  of  Quality  " 
Est.  18S7.  New  York 


Tamaica  Printintf  ("omipiniy,   .Tanutica  Plain,   Boston.   Mass. 


RETURN 
TO 


.  642-4493 


BIOSCIENCE 
LIBRARY 
5 40UianntntHi% 


ALL  BOOKS  MAY  BE  RECALLED  AFTER 


oner 

\fTER  7  DAYS 


DUE  AS  STAMPED  BELOW 


P.rcE<\-£-^ 


BlOSCldNCe 


I     Jt/N  0  i  1933 


'^M^ga^a 


WAY  25.2PM 


Ml 


J^LlZm. 


BIOS 


MW  02*94 -US2 


AM 


UNIVERSITY  OF  CALIFORNIA,  BERKELEY 
FORM  NO.  DDO,  50m,  1/82  BERKELEY,  CA  94720 


®» 


\-/-\     /-^Z    Z.W 


®» 


U.C.  BERKELEY  LIBRARIES 

nMiiiiHiii 


CD5imoa35 


